1. Two years of Call 4 Concern (C4C): patient and relative activated critical care outreach Dr. Mandy Odell Nurse Consultant, Critical Care BACCN conference 2012

2. Call 4 Concern (C4C): patient and relative initiated Outreach Presented at the BACCN conference in 2010

3. Background Josie King www.josieking.org Lewis Blackman www.lewisblackman.net

4. Why use it?  ‘If I would have been able to call a rapid response team, I believe Josie would be here today,’ says Sorrel King.  Helen has “not a shred of doubt” that a rapid response team would have saved her son.

5. Over a 6 month period (Sept 09 – Mar 10), all patients, and their relatives, transferring out of the intensive care unit (ICU) to the wards were given access to using the C4C service: -feasibility -resource -value -outcome Pilot

6. Development Rolled out across all wards Maternity Paediatrics

7. Results CategoryCCO response to C4C 1Critical clinical intervention, and/or re- admission to ICU 2 2Clinical intervention such as pain relief.2 3Investigative intervention, such as ordering or speeding up investigations 3 4Liaising with medical team to get clarification and communication with family/patient 3 5Re-assurance to patient/family2

8. Issues highlighted during the study It is relatives more than patients that engage with the C4C process and raise concerns Making sure the right people get the information Access to calling systems needs to be improved Addressing concerns with ward teams Reassuring patients and relatives about ongoing care CCO able to cope with demand (but will need reassessing when rolled out)

9. “It was reassuring to know it (C4C) was there” “You feel so vulnerable when you leave ICU to go to the ward” “I tried not to be concerned but in my heart I was frightened” “I put all my efforts into worrying rather than concentrating on getting better” “…when I raised the issues with her team, they heard but didn’t seem to listen…” “If I hadn’t had C4C I would have had to find another way to voice my concerns: taking time and draining energy when you have little of both” What they said..

10. Nursing Times & Health Service Journal March 2011 Patient Safety: Intensive and Critical Care Just amazing! Huge potential to be developed further We should all be doing this This is very good practice

11. Critical Care Outreach Monthly referrals to Outreach

12. C4C – 147 calls received Trust wide since end of April 2011

13. 147 calls 97 patients 34 had prior involvement with ICU 1 pt had 9 C4C, and 7 OR calls 17 “other” calls 7 calls from Obstetrics3 calls from Paediatrics

14. Clinical Concern50 (2 ICU admissions) Communication35 Reassurance / Support26 Other17 General nursing / ward care10 Discharge Planning9 Total147

15. “Other” calls  Relatives stuck in lift…  Mum phoned from Mumbai – her son was admitted with a “broken leg” she is unable to track him down…  Found relatives outside of Recovery in distress – pt had been in recovery for > 6 hours: described ward staff us “unhelpful & rude”, not providing any information…  Lost filling…  Wife unable to visit husband (in-patient) due to fractured ankle – now in rehab. Very concerned & distressed…..

16. Ongoing issues -Posters, poster boards & DVD -Feedback from patients & relatives -Introduction into Paediatrics & Obstetrics -Any ideas???

17. Any questions? mandy.odell@royalberkshire.nhs.uk karin.gerber@royalberkshire.nhs.uk mandy.odell@royalberkshire.nhs.uk

18. Any questions? mandy.odell@royalberkshire.nhs.uk