Introducing Critical Care Outreach: a ward-randomised trial of phased introduction in a general hospital

Intensive Care Med. 2004 Jul;30(7):1398-404. doi: 10.1007/s00134-004-2268-7. Epub 2004 Apr 27.


Objective: The purpose of the study was to investigate the effects of introducing a critical care outreach service on in-hospital mortality and length of stay in a general acute hospital.

Design: A pragmatic ward-randomised trial design was used, with intervention introduced to all wards in sequence. No blinding was possible.

Setting: Sixteen adult wards in an 800-bed general hospital in the north of England.

Patients and participants: All admissions to the 16 surgical, medical and elderly care wards during 32-week study period were included (7450 patients in total, of whom 2903 were eligible for the primary comparison).

Interventions: Essential elements of the Critical Care Outreach service introduced during the study were a nurse-led team of nurses and doctors experienced in critical care, a 24-h service, emphasis on education, support and practical help for ward staff.

Measurements and results: The main outcome measures were in-hospital mortality and length of stay. Outreach intervention reduced in-hospital mortality compared with control (two-level odds ratio: 0.52 (95% CI 0.32-0.85). A possible increased length of stay associated with outreach was not fully supported by confirmatory and sensitivity analyses.

Conclusions: The study suggests outreach reduces mortality in general hospital wards. It may also increase length of stay, but our findings on this are equivocal.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Community-Institutional Relations / standards*
  • Critical Care*
  • Female
  • Hospital Mortality
  • Hospitals, General / organization & administration
  • Hospitals, General / standards*
  • Hospitals, General / statistics & numerical data
  • Humans
  • Inpatients
  • Length of Stay
  • Male
  • Middle Aged
  • Patient Admission
  • Proportional Hazards Models