title: Evaluation of critical care outreach services in a tertiary care Hospital in India: A retrospective analysis.
abstract: BACKGROUND
  Critical care outreach services (CCOS) is a relatively a new concept in India and is not as developed as in Western countries. Efficient utilization of limited intensive care service requires comprehensive CCOS. Appropriate activation of such services will limit excess burden on already scarce human resources.
  
  
  OBJECTIVE
  To evaluate the functioning of CCOS in a tertiary care hospital and also to identify factors leading to its overactivation.
  
  
  METHODS
  Data of 400 calls received in resuscitation room (RR) of the Trauma Center during January 2011-June 2011 was analyzed. Categorical variables were summarized by calculating the frequency and percentage. Records of the department sending the call, purpose of the calls, and designation of the person sending the calls were noted. Calls were grouped into appropriate or inappropriate.
  
  
  RESULTS
  Maximum calls were received from medicine wards (65.8%) followed by neurosurgery ward (12.5%). Of all, 26% of the calls were sent by senior doctors (senior resident), whereas 69.4% of the calls were sent by junior doctors. 66.2% of the calls were indicated for assessment and intensive care unit (ICU) transfer, whereas central venous/intravenous access constituted 14.8% of the calls. Intubation and ventilator settings constituted 7.3 and 7.8% calls, respectively. About one-third (36.2%) of all calls were inappropriate.
  
  
  CONCLUSIONS
  There is inefficient use of human resources in CCOS in our hospital. Lack of objective activation criteria and inefficient training in basic lifesaving skills and ventilator know-how were identified as primary factors for the same.
authors.affiliation: Department of Anaesthesiology and intensive care, Pushpanjali Crosslay Hospital, Vaishali, Gaziabad, Uttar Pradesh, India.
authors.forename: Nidhi
authors.initials: N
authors.lastname: Srivastava
authors.affiliation: Department of Anaesthesiology and intensive care, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India.
authors.forename: Mohan Deep
authors.initials: MD
authors.lastname: Kaur
authors.affiliation: Department of Anaesthesiology, Institute of Liver and Biliary Sciences, New Delhi, India.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Sharma
keywords: Appropriate calls; critical care outreach services; early warning scores; human resource wastage
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