title: Critical care outreach: the need for effective decision-making in clinical practice (Part 1).
abstract: Since the publication of 'Comprehensive Critical Care' (2000) critical care outreach (CCOR) services have been developed to meet the needs of patients through critical care provision 'without walls'. Now embedded nationally, CCOR is a central part of health care delivery in the National Health Service (NHS). To date, approximately 75% of hospitals in England have introduced and developed the service according, at least to some extent, to local needs and resources. While this has resulted in a somewhat inconsistent approach to the development and configuration of these services, a number of common elements remain. Arguably, effective clinical decision-making by CCOR practitioners is fundamental to efficient patient care management and the success of these services. In its examination of CCOR service provision this, the first of two papers, addresses the theoretical background of clinical decision making and the knowledge that underpins practice in CCOR. In the second paper, through collaborative reflection and analysis of a case study, the authors bring these together in a process that illuminates the realities of clinical decision making for CCOR practitioners. From this, recommendations are made about the future development of CCOR practitioners and services.
authors.affiliation: Centre for Integrated Health Care Research, School for Health, Durham University, United Kingdom. Helen.Hancock@Durham.ac.uk
authors.forename: Helen C
authors.initials: HC
authors.lastname: Hancock
authors.forename: Lesley
authors.initials: L
authors.lastname: Durham
mesh_terms: D002983:Clinical Competence; D003071:Cognition; D003159:Community-Institutional Relations; D003422:Critical Care / Q000458:organization & administration*; D003463:Cues; D003625:Data Collection; D003627:Data Interpretation, Statistical; D003659:Decision Making, Organizational; D003661:Decision Support Techniques; D017598:Efficiency, Organizational; D004739:England; D019317:Evidence-Based Medicine; D006808:Humanism; D006801:Humans; D019545:Intuition; D019359:Knowledge; D016294:Models, Nursing; D020380:Needs Assessment / Q000458:organization & administration*; D009730:Nursing Assessment / Q000458:organization & administration; D009736:Nursing Process / Q000458:organization & administration*; D010687:Philosophy, Nursing; D013222:State Medicine / Q000458:organization & administration