Survey says: CCOT needs you in more ways than one!
Submitted by Vini Bains , clinical nurse specialist, Critical Care
Critical Care Outreach Team members (l-r): Vini Bains, CNS, Critical Care; Sean Case, RRT; Liana Perruzza, ICU/CCOT RN; Annie Kim, ICU/CCOT RN; Kiley Moore-Dempsey, ICU/CCOT RN
The Critical Care Outreach Team (CCOT) is a new service that brings an interdisciplinary team of critical care experts to in-patients anywhere in hospital. The aim of CCOT is to work collaboratively with primary care teams to enhance patient safety. However, creating a safer hospital is no simple task, and implementing a CCOT service does not guarantee improvements in patient outcomes. In fact there are multiple factors we need to get right.
Some of the keys to success include the need for CCOT to be fast, reliable, approachable, collaborative, and as per our motto, ward clinicians need to “call early, call often!” Essentially, improving patient outcomes hospital-wide is dependent on ward clinicians’ willingness to activate CCOT often, and early. For a hospital the size of St. Paul’s, research recommends aiming for 17 or more CCOT activations (i.e. new calls) per week.
As we head into CCOT’s fourth month, how are we doing? It does appear CCOT activity has remained high since the launch. On average CCOT makes 76.6 patient visits per week, 19.1 of which are new CCOT activations; while scheduled follow-ups (41.4), ICU follow-ups (20.3) and other contact types (5.7) make up all other CCOT visits.
The top 3 reasons why CCOT is activated is primary clinician is worried about something (58%), respiratory changes (35%) and cardiovascular changes (24%). While 87% of the time, the patient has remained on their home ward, every CCOT member has stories to tell about just-in-time transfers to a higher level of care.
But is CCOT being called early enough? The biggest difference we can make to a patient’s trajectory is not found in the heroic saves, but rather it is small moments of curiosity that drive thousands of tiny, slightly better decisions. While it’s rewarding to be there just in time, one wonders what could have been, if CCOT was activated sooner?
Tools like the Modified Early Warning Score (MEWS) are designed to trigger clinicians at a much earlier stage of clinical deterioration, when small interventions can make a big difference. To date an elevated MEWS has been identified as the trigger for CCOT only five times. We may be under-reporting when MEWS contributes to CCOT activation or changes in care, but it is also possible that we are missing some opportunities.
We need further inquiry, not only to better understand what contributes to missed opportunities, but also, to improve this new CCOT service. This is the other reason CCOT needs you now. We invite anyone who has had any experience with CCOT to participate in the CCOT Evaluation Survey.
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