Introducing Critical Care Outreach: a ward-randomised trial of phased introduction in a general hospital.
OBJECTIVE
The purpose of the study was to investigate the effects of introducing a critical care outreach service on in-hospital mortality and length of stay in a general acute hospital.


METHODS
A pragmatic ward-randomised trial design was used, with intervention introduced to all wards in sequence. No blinding was possible.


METHODS
Sixteen adult wards in an 800-bed general hospital in the north of England.


METHODS
All admissions to the 16 surgical, medical and elderly care wards during 32-week study period were included (7450 patients in total, of whom 2903 were eligible for the primary comparison).


METHODS
Essential elements of the Critical Care Outreach service introduced during the study were a nurse-led team of nurses and doctors experienced in critical care, a 24-h service, emphasis on education, support and practical help for ward staff.


RESULTS
The main outcome measures were in-hospital mortality and length of stay. Outreach intervention reduced in-hospital mortality compared with control (two-level odds ratio: 0.52 (95% CI 0.32-0.85). A possible increased length of stay associated with outreach was not fully supported by confirmatory and sensitivity analyses.


CONCLUSIONS
The study suggests outreach reduces mortality in general hospital wards. It may also increase length of stay, but our findings on this are equivocal.
Priestley
George
G
York Hospitals NHS Trust, Bootham Park, York, YO30 7BY, UK.
Watson
Wendy
W
Rashidian
Arash
A
Mozley
Caroline
C
Russell
Daphne
D
Wilson
Jonathan
J
Cope
Judith
J
Hart
Dianne
D
Kay
Diana
D
Cowley
Karen
K
Pateraki
Jayne
J
D000368:Aged; D003159:Community-Institutional Relations / Q000592:standards*; D003422:Critical Care; D005260:Female; D017052:Hospital Mortality; D006769:Hospitals, General / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D016016:Proportional Hazards Models