Introduction

The way in which we provide critical care is changing. However, resources are limited, and are likely to remain so. Outcomes are improving, and many clinicians feel that the care of sick patients outside of the critical care itself is an area that could be significantly improved. Therefore, critical care outreach has been developed, and is mainly managed by the medical and nursing staff on the critical care units.

Theory

Outreach involves exporting skills and knowledge from the critical care area into the general ward environment. The purpose is early recognition of signs and symptoms that may predict deterioration in the patients' condition and, by timely intervention, reversing the deterioration and therefore avoiding critical care admission, major morbidity or death. However, if admission to the critical care is required, early recognition allows timely transfer, which minimizes patient risk and optimizes outcome. This approach should theoretically also improve overall care on the general ward, allowing earlier safe discharge of critical care patients.

The team

The idea of critical care outreach has been suggested in many forms. The ‘medical emergency team’ (MET) concept was developed in Liverpool, New South Wales (Australia) in 1989. This concept involves ward staff contacting a team of senior medical and nursing staff from critical care areas when a set of physiological parameters are breached or whenever concern is expressed, so-called track-and-trigger systems.