N Pattison, Clinical Nursing Research Fellow, CCU Outreach Office, The Royal Marsden NHS Foundation Trust, Sutton, Surrey SM2 5PT, UK.
Nurs Crit Care. 2012 Mar-Apr;17(2):71-82. doi: 10.1111/j.1478-5153.2011.00464.x. Epub 2011 Jul 20.
To explore referrals to a critical care outreach team (CCOT), associated factors around patient management and survival to discharge, and the qualitative exploration of referral characteristics (identifying any areas for service improvement around CCOT).
A single-centre mixed method study in a specialist hospital was undertaken, using an explanatory design: participant selection model. In this model, quantitative results (prospective and retrospective episode of care review, including modified early warning system (MEWS), time and delay of referral and patient outcomes for admission and survival) are further explained by qualitative (interview) data with doctors and nurses referring to outreach. Quantitative data were analysed using SPSS +17 and 19, and qualitative data were analysed using grounded theory principles.
A large proportion of referrals (124/407 = 30·5%) were made by medical staff. For 97 (97/407 = 23·8%) referrals, there was a delay between the point at which patients deteriorated (as verified by retrospective record review and MEWS score triggers) and the time at when patients were referred. The average delay was 2·96 h (95% CI 1·97-3·95; SD 9·56). Timely referrals were associated with improved outcomes; however, no causal attribution can be made from the circumstances around CCOT referral. Qualitative themes included indications for referral, facilitating factors for referral, barriers to referral and consequences of referral, with an overarching core theory of reassurance. Outreach was seen as back-up and this core theory demonstrates the important, and somewhat less tangible, role outreach has in supporting ward staff to care for at-risk patients.
Mapping outreach episodes of care and patient outcomes can help highlight areas for improvement. This study outlines reasons for referral and how outreach can facilitate patient pathways in critical illness.
探索向重症监护外展团队（CCOT）转介的情况，探讨与患者管理和出院生存相关的因素，并对转介特征进行定性探索（确定 CCOT 服务改进的任何领域）。
在一家专科医院进行了一项单中心混合方法研究，采用解释性设计：参与者选择模型。在该模型中，通过对医生和护士进行外展转诊的定性（访谈）数据，进一步解释定量结果（前瞻性和回顾性的治疗回顾，包括改良早期预警系统（MEWS）、转诊时间和延迟以及入院和生存的患者结局）。使用 SPSS+17 和 19 对定量数据进行分析，使用扎根理论原则对定性数据进行分析。
很大一部分转介（407 例中的 124 例，30.5%）是由医务人员进行的。对于 97 例（407 例中的 97 例，23.8%）转介，在患者恶化（通过回顾性记录审查和 MEWS 评分触发验证）和转介之间存在延迟。平均延迟时间为 2.96 小时（95%CI 1.97-3.95；SD 9.56）。及时转介与改善结局相关；然而，不能从 CCOT 转介的情况中做出因果归因。定性主题包括转介的指征、转介的促进因素、转介的障碍和转介的后果，其核心理论是安心。外展被视为后备支持，这一核心理论展示了外展在支持病房工作人员照顾高危患者方面的重要作用，尽管这种作用有些难以量化。
映射外展治疗的情况和患者结局可以帮助突出改进的领域。本研究概述了转介的原因以及外展如何促进危重病患者的治疗途径。
