Expanding the walls of the intensive care unit

Mr. Smith’s bedside nurse on the medical unit at the Oakville-Trafalgar Memorial Hospital (OTMH) notices that her 70-year old patient is having difficulty breathing, his heart rate is soaring and he is incoherent. Concerned about these sudden unusual changes in Mr. Smith’s condition, the nurse pages the patient’s physician and the Critical Care Outreach Team for help.

“New, acute changes in the patient’s vitals, as well as any other serious medical concerns are criteria for calling the team,” explains Eileen McDonald-Karcz, Halton Healthcare Services (HHS) Cardiac Professional Practice Clinician and Team Leader of the Critical Care Outreach Team (CCOT) at OTMH. “The earlier we recognize these indicators and intervene, the better our chances in preventing cardiac arrest and saving the patient’s life.”

Halton Healthcare Services was one of 26 hospitals across the province to receive funding for the establishment of a Critical Care Outreach Team at OTMH. The announcement of $1.04 million for the CCOT was part of the province’s comprehensive plan to improve access to critical care. As one of two Ontario community hospitals involved in the Ministry’s CCOT pilot project since August 2005, this funding means that HHS can continue with this successful program.

Under the guidance of Dr. Laurence Chau, Intensive Care Unit (ICU) Medical Director at OTMH and Eileen McDonald-Karcz, the Critical Care Outreach Team is available 24/7 to any unit within OTMH. Comprised of specially trained ICU doctors, nurses (and respiratory therapists, as necessary), this resource team takes the skills, expertise, and equipment of the ICU to the medical units of the hospital to stabilize a patient whose condition is deteriorating. Their quick medical intervention can often fast-track the patient to ICU for immediate critical care or prevent an ICU admission.

“Patients who are admitted to the hospital today are increasingly sicker and require more complex care. During our pilot phase we found that having this critical care resource available to support and work in partnership with the nurses and physicians on our care units has been a win-win for all concerned,” explains Dr. Chau. “The patient gets the specialized care they need without having to be in the ICU, our nurses develop their critical care skills, and another ICU bed is available for the next patient who absolutely needs it. Based on the preliminary findings of the provincial pilot project, the Ministry has rolled out this program province-wide. This is very encouraging.”

“We have provided educational inservice sessions on each patient care unit at OTMH to heighten awareness of the early warning signs of clinical deterioration, as well as provide information on how and when to call the CCOT,” continued Mrs. McDonald-Karcz.

When the Team is paged, a Critical Care Nurse responds immediately. She or he assesses the patient’s condition and, working in tandem with the ICU Intensivist on-call, provides the necessary follow-up or medical intervention to stabilize the patient. “Each CCOT experience provides an opportunity for the team to share their knowledge with the ward nurses. This in turn prepares them for the next critical situation,” explains Mrs. McDonald-Karcz.

“The CCOT plays a vital role in coaching and mentoring,” adds Dionne Reelis, Clinical Resource Nurse on OTMH’s 2 Centre Surgical Unit. “Working closely with this team has honed the critical care skills on our unit. Now we are even more vigilant of all the possible clinical changes and their significance. This is an amazing resource which expands the walls of the ICU to the rest of the hospital.”

During their daily rounds the team also follows-up on the condition of patients who have been recently discharged from the ICU to various care units throughout the hospital. “This proactive measure confirms that these patients are continuing to improve clinically and prevents the need to readmit them to the ICU,” concludes Mrs. McDonald-Karcz.

“At HHS the CCOT has heightened patient safety, increased access to critical care, and improved the use of critical care resources throughout our hospital,” explains Dr. Laurence Chau. “We were fortunate to be part of the pilot and are thrilled to be able to continue with this invaluable initiative. It has and will continue to save lives.”