Abstract
Abstract
Introduction
It is not known whether the implementation of Critical Care Outreach improves patient outcomes of deteriorating patients on acute hospital wards. It is important to reassess the evidence in this Cochrane update.
Aim
To determine the effectiveness of Critical Care Outreach services on hospital mortality rates, ICU admission patterns, length of hospital stay and incidence of serious adverse events of adult patients who deteriorate on acute hospital wards.
Methods
We searched Central, CDSR, DARE, HTA, NHSEED, Embase, Cinhal (EBSCO), Amed, Clinical Trails.gov, HMIC, Medline, PsychINFO and WHO International Clinical Trials Registry Platform (ICTRP), Science Citation Index databases from 2006-2016 for relevant studies and searched reference lists of relevant articles, conference abstracts, and made contact with experts and critical care organisations for further information. All randomised controlled trials, controlled before and after and interrupted time series designs that met the inclusion criteria were included. All studies were screened, data extracted and quality assessed independently by two reviewers. Study quality was assessed using the Cochrane risk of bias tools for randomised and non-randomised studies.
Results
Seven studies met the inclusion criteria; five non-randomised studies from this update and two randomised studies from the previous version of the review. The overall strength of evidence to inform decisions regarding the implementation and funding of RRS is inconclusive. We judged the certainty of evidence for the effectiveness of EWS and RRS on mortality, unanticipated cardiac arrest, unplanned ICU admission and length of stay as low to very low due to the methodological limitations of the included studies and limited data contributing to our outcomes of interest.
Conclusion
The findings from this systematic review highlight the heterogeneity and poor methodological rigour of current research. There is a need for core outcome sets to be developed to facilitate meaningful comparison and meta-analysis of Outreach data.
Introduction
It is not known whether the implementation of Critical Care Outreach improves patient outcomes of deteriorating patients on acute hospital wards. It is important to reassess the evidence in this Cochrane update.
Aim
To determine the effectiveness of Critical Care Outreach services on hospital mortality rates, ICU admission patterns, length of hospital stay and incidence of serious adverse events of adult patients who deteriorate on acute hospital wards.
Methods
We searched Central, CDSR, DARE, HTA, NHSEED, Embase, Cinhal (EBSCO), Amed, Clinical Trails.gov, HMIC, Medline, PsychINFO and WHO International Clinical Trials Registry Platform (ICTRP), Science Citation Index databases from 2006-2016 for relevant studies and searched reference lists of relevant articles, conference abstracts, and made contact with experts and critical care organisations for further information. All randomised controlled trials, controlled before and after and interrupted time series designs that met the inclusion criteria were included. All studies were screened, data extracted and quality assessed independently by two reviewers. Study quality was assessed using the Cochrane risk of bias tools for randomised and non-randomised studies.
Results
Seven studies met the inclusion criteria; five non-randomised studies from this update and two randomised studies from the previous version of the review. The overall strength of evidence to inform decisions regarding the implementation and funding of RRS is inconclusive. We judged the certainty of evidence for the effectiveness of EWS and RRS on mortality, unanticipated cardiac arrest, unplanned ICU admission and length of stay as low to very low due to the methodological limitations of the included studies and limited data contributing to our outcomes of interest.
Conclusion
The findings from this systematic review highlight the heterogeneity and poor methodological rigour of current research. There is a need for core outcome sets to be developed to facilitate meaningful comparison and meta-analysis of Outreach data.
Original language | English |
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Publication status | Published - 13 Feb 2019 |
Event | European Federation of Critical Care Nurses Association Congress 2019 - Ljubljana, Slovenia Duration: 13 Feb 2019 → 16 Feb 2019 |
Conference
Conference | European Federation of Critical Care Nurses Association Congress 2019 |
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Abbreviated title | EfCCNa 2019 |
Country/Territory | Slovenia |
City | Ljubljana |
Period | 13/02/2019 → 16/02/2019 |