Critical Care Outreach Team

Abstract

Introduction: Critical Care Outreach Team is established to timely identify sick patients outside ICU and initiate proper therapy before they deteriorate. This study was performed to evaluate the effect of CCOT in a tertiary center in Nepal.

Methods: This is a before-after comparative study conducted in a level II postoperative ward in Nepal. CCOT was established which comprised of an Intensivist, ICU resident and critical care nurse. The outcome of patients three months before and three months after the establishment of CCOT were compared.

Results: In pre-CCOT period, there were 582 admissions, among which 538 (92.4%) patients were admitted for postoperative care and 27 (4.63%) patients were critically ill and fifteen were intubated. Among 582 patients, 531 got better and transferred out but 9 of them got readmitted again within 48 hours. In the post-CCOT period, there were 561 admissions, among which 512 (91.2%) were admitted for postoperative care and 22 (3.92%) were critically ill and only 10 of them got intubated and shifted to ICU. Among 561 patients, 491 improved and were transferred out and 7 got readmitted only after 96 hours. Another 10 patients goals of care were discussed and DNI/DNR order instituted and end of life care was given for them who later expired at Postoperative ward.

Conclusions: This shows that CCOT intervention outside ICU is important to reduce ICU admissions, decrease early readmission and clarify goals of care prior to ICU.