An evaluation of the contribution of critical care outreach to the clinical management of the critically ill ward patient in two acute NHS trusts.

This paper reports on an evaluation of the role and contribution of outreach in the management of the critically ill ward patient using Stake's Responsive Model (Stake, 1975) and case study methodology (Simons, 1980). Twenty cases were examined, purposefully sampling all staff involved in the case identified by an initial interview with the outreach nurse. In total, 80 interviews were carried out, 20 with the outreach nurses and 54 with other members of health care teams involved in the cases, and six further targeted in-depth interviews with senior anaesthetic and nursing staff.

Nursing observations on ward patients at risk of critical illness.

Research findings and anecdotal evidence from outreach nurses across the country have suggested that key indicators of critical illness (respiratory rate and fluid balance) are being missed on the wards and that critically ill patients are not being fed adequately. A group of outreach nurses in Kent carried out a survey to confirm or refute these claims and to ascertain the variation in outreach provision in Kent. The survey found widespread deficiencies in nursing care and observations, which represent a serious threat to patients' safety.

Points of view.

As a nurse in a small district general hospital, I have been called upon to accompany patients who are being transferred to London hospitals for specialist treatment of conditions such as renal or hepatic failure, acute head injury and ischaemic heart disease.