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Critical Care Outreach Teams and COVID-19

Lee McDonald

Department of Health recommendations in 2000 and had three main aims; 1) avert ICU admissions, 2) enable discharges from ICU and 3) to share critical care skills outside of the ICU (Department of Health, 2000).20 years on, CCOT’s have grown in popularity throughout the UK with roles changing to meet the needs of their hospital trusts and the populations they serve, both patients and staff (National Institute for Health and Care Excellence, 2018). However, role variation and difficulty in defining and measuring global outcomes has meant that, while trusts anecdotally report the benefit of CCOT’s, confirmation of their clinical efficacy and cost-effectiveness in the form of robust studies is lacking (Bohlin, 2020; Garry, Rohan, O'Connor, Patton, & Moore, 2019; Marsh & Pittard, 2012).A National Institute of Health and Clinical Excellence (NICE) (2018) committee reviewed the available literature on CCOT’s clinical efficacy and economic value to help review whether NHS CCOT services should be established 24 hours, 7 days a week. A Cochrane review and 3 randomised control trials (comprised of 4 papers) were reviewed, and 7 outcomes identified. These were; in-hospital mortality, length of stay, cardiac arrest, cardiopulmonary resuscitation, unplanned ICU admission, ICU admission and DNAR orders issued. The quality of the evidence evaluating all outcomes varied from ‘very low’ to ‘moderate’ due to ‘risk of bias, ‘imprecision’ and ‘inconsistency’ (National Institute for Health and Care Excellence, 2018).The NICE (2018, p. 16) committee highlight that CCOT offer “complex interventions which are poorly characterised in the research literature”. Confounding factors such as lack of role standardisation, and contextual and social factors make CCOT’s clinical efficacy and economic value difficult to measure. These aspects force the hand of institutions to make recommendations based on pragmatism rather than evidence