The Sunderland CCOT objectives remain those identified by DOH (2000): Avert admissions by identifying patients who are deteriorating and either helping to prevent admission or ensuring that admission to a critical care bed happens in a timely manner to ensure best outcome. Enable discharges by supporting the continuing recovery of discharged patients on wards and their relatives and friends. Share critical care skills with staff in wards and the community ensuring enhancement of training opportunities and skills practice and to use information gathered from the ward and community to improve critical care services for patients and relatives.   In support of these objectives the Critical Care Outreach Team (CCOT) of Sunderland Royal Hospital (SRH) will: Maintain a referral service, accessible by all members of the multidisciplinary team, to all adult areas within SRH via the hospital bleep system.   Review all patients referred irrespective of reason for referral. Promote effective use of the combined observation chart and the National Early Warning Score (NEWS) in all adult areas within SRH (See section 9). Follow-up all transfers from ICCU on all ward areas (enabling discharges from critical care back to the wards by providing support for ward staff in giving safe and seamless care). Educate and train the Multidisciplinary Team n the recognition and initial management of acutely and critically ill patients, NEWS and the agreed acutely ill patient pathway Ensure full integration of the service with the work of the Integrated Critical Care Unit. Audit and evaluate critical care outreach activity, effectiveness and outcomes. Share good practice at a local, regional, national and inter-national level. The CCOT also contributes to the Cardiac Arrest Team between the hours of midnight to 08.00 (not considered true “outreach” work). The CCOT

Recent Developments: Electronic trawl for acutely ill patients not referred 2. Call 4 Concern

C4C Implementation Plan Stage 1 Provide all patients transferred from the Integrated Critical Care Unit (ICCU) with written information about the role and function of the CCOT, how to contact the team and the circumstances in which calls will be encouraged. ü Stage 2 Audit and evaluation of Stage one: assess utility of the service and its perceived value to patients, families and staff members. ü Stage 3 Expansion of the service to include all patients otherwise referred to the Team ü Stage 4 Audit and evaluation of Stage Three Stage 5 Expansion of the service to include all patients