An evaluation of the evidence base related to critical care outreach teams--2 years on from Comprehensive Critical Care.

It is now 2 years since the publication of Department of Health [Comprehensive Critical Care: A Review of Adult Critical Care Services (2000a)] document 'Comprehensive Critical Care'. One of its' main recommendations was the introduction of critical care outreach services. Many hospitals have since established such services and are providing education for ward nurses and house officers, and follow-up for patients discharged from intensive care when they return to a general ward. Early Warning Scoring (EWS) systems have also been introduced onto the wards to improve the identification of patients deteriorating into critical illness. However, as yet there appears to be little evidence that this investment has been worthwhile in terms of improving patient outcomes, such as reduction in cardiac arrests on the wards, reduction in unplanned admissions to critical care or earlier referrals to critical care. With many outreach teams hoping to expand their services in the future there is a pressing need to demonstrate an impact. We must remember however that some outreach teams have only been in post for 12 months and so it may therefore be far too early to reliably demonstrate any effect.