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9 - Critical care outreach: 6 years on

Published online by Cambridge University Press:  15 December 2009

Lesley Durham
Affiliation:
City Hospitals Sunderland NHS Foundation Trust Royal Hospital Kayll Road Sunderland SR4 7TP UK
Brian H. Cuthbertson
Affiliation:
Health Services Research Unit Institute of Applied Health Sciences Polwarth Building Medical School University of Aberdeen Foresterhill Aberdeen AB25 2ZD Scotland
Jeremy Cashman
Affiliation:
St George's Hospital, London
Michael Grounds
Affiliation:
St George's Hospital, London
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Summary

It has been nearly six years since ‘Comprehensive Critical Care’ heralded the introduction of Critical Care Outreach services in England. Whilst still the source of much critical debate, Critical Care Outreach has been, and remains, a central feature of recent approaches to address capacity pressures, and the management of the ever increasing numbers of acutely unwell and critically ill patients in National Health Service (NHS) hospitals regardless of their location – the oft cited ‘Critical Care without Walls’ approach.

Context and background of critical care outreach

Critical and acute care provision in England has changed drastically over the last 20 years. Between 1982 and 1995 there was a 25% decrease in the number of acute hospital beds. At the same time the population has grown and demand increased. The provision of critical care is made more difficult in the UK by factors such as low levels of staffing compared to other developed countries, an ageing population, the availability of increasingly complex clinical procedures, the increasing number of patients requiring Level 1 care in general wards, increased public awareness and expectation, changes in nursing education and staffing, changes in medical education and work practices including the new consultant contract, European Working Time Directive and Modernising Medical Careers. This has led to an inadequate provision of critical care beds.

For many years clinical intuition, clinical experience and anecdotal evidence have suggested that care offered to patients in the period preceding transfer to the intensive care unit (ICU) is often inadequate.

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Chapter
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Publisher: Cambridge University Press
Print publication year: 2007

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  • Critical care outreach: 6 years on
    • By Lesley Durham, City Hospitals Sunderland NHS Foundation Trust Royal Hospital Kayll Road Sunderland SR4 7TP UK, Brian H. Cuthbertson, Health Services Research Unit Institute of Applied Health Sciences Polwarth Building Medical School University of Aberdeen Foresterhill Aberdeen AB25 2ZD Scotland
  • Edited by Jeremy Cashman, Michael Grounds
  • Book: Recent Advances in Anaesthesia and Intensive Care
  • Online publication: 15 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544521.010
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  • Critical care outreach: 6 years on
    • By Lesley Durham, City Hospitals Sunderland NHS Foundation Trust Royal Hospital Kayll Road Sunderland SR4 7TP UK, Brian H. Cuthbertson, Health Services Research Unit Institute of Applied Health Sciences Polwarth Building Medical School University of Aberdeen Foresterhill Aberdeen AB25 2ZD Scotland
  • Edited by Jeremy Cashman, Michael Grounds
  • Book: Recent Advances in Anaesthesia and Intensive Care
  • Online publication: 15 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544521.010
Available formats
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Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Critical care outreach: 6 years on
    • By Lesley Durham, City Hospitals Sunderland NHS Foundation Trust Royal Hospital Kayll Road Sunderland SR4 7TP UK, Brian H. Cuthbertson, Health Services Research Unit Institute of Applied Health Sciences Polwarth Building Medical School University of Aberdeen Foresterhill Aberdeen AB25 2ZD Scotland
  • Edited by Jeremy Cashman, Michael Grounds
  • Book: Recent Advances in Anaesthesia and Intensive Care
  • Online publication: 15 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544521.010
Available formats
×