Critical care outreach during the COVID-19 pandemic: An observational study.

Abstract

BackgroundSince the beginning of the coronavirus disease 2019 (COVID‐19) outbreak, the Critical Care Outreach Team (CCOT) remained operational to provide critical care support to acutely ill and deteriorating patients on the wards. We aimed to evaluate the demand and efficacy of the critical care outreach service during the COVID‐19 pandemic.MethodWe prospectively evaluated all patients referred to critical care outreach enrolled during a twelve‐month period. We reported the cumulative number of activities and interventions and baseline characteristics, acuity level and patients' clinical outcome. The rate of ICU admissions, activity plan, patients' acuity and mortality are compared to historical data pre‐pandemic.ResultsAmongst 4849 patients referred, 3913 had a clinical review and of those 895 were COVID‐19 positive. Non‐invasive ventilation was mostly delivered to COVID‐19 patients (COVID‐19 +VE: 853/895, 95% vs. COVID‐19 −VE: 119/3018, 4%) alongside awake prone positioning (COVID‐19 +VE: 232/895, 26% vs. COVID‐19 −VE: 0/3018, 0%). Compared to pre‐pandemic, the cumulative number of patients assessed increased (observed: 3913 vs. historical: 3615; p = 0.204), patients meeting Level 2 acuity were higher (observed: 51% vs. historical: 21%; p = 0.003), but ICU admission rate did not increase significantly (observed: 12% vs. historical: 9%; p = 0.065), and greater mortality rate (observed: 14% vs. historical: 8%; p = 0.046) was observed.ConclusionCritical care outreach bridges the gap between the intensive care unit and general wards and supports the concept of ‘critical care without walls’ acting as a valuable resource in optimizing and triaging acutely unwell patients and potentially averting critical care admissions.Relevance to Clinical PracticeThe COVID‐19 pandemic has generated an unprecedented surge of deteriorating and critically ill patients with has caused severe and sustained pressures on intensive care units (ICUs) and general wards. Acutely ill patients can deteriorate quickly, and early recognition is vital to commence critical intervention on the wards or transfer timely to ICU.The Critical Care Outreach Team can help staff and optimize acutely ill and deteriorating patients by providing timely critical care interventions at the patient bedside.