Abstract
An evaluation of critical care outreach services was published in the previous issue of Critical Care that fails to demonstrate any important outcome benefit associated with these services. It is now time to ask some difficult questions about the future of outreach, including whether the lack of evidence should lead to disinvest-ment in such services.
Highlights
critical care outreach services (CCOS) losing its youth produces an urgent requirement for efficacy and cost-effectiveness to be demonstrated
The study failed to demonstrate a reduction in intensive care unit (ICU) admissions, cardiac arrests or inhospital mortality
Since the publication of the MERIT study, proponents of CCOS have commonly stated that CCOS cannot be tested using a randomised controlled trial design, and some proponents seemed to believe that supportive evidence was not required at all [1]
Summary
CCOS losing its youth produces an urgent requirement for efficacy and cost-effectiveness to be demonstrated. The most detailed evaluation to date of these systems is the MERIT study from Australia, which was a multicentre cluster randomised trial of METs [6]. The study failed to demonstrate a reduction in intensive care unit (ICU) admissions, cardiac arrests or inhospital mortality.
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