An additional element of mature Australian critical care outreach services is the intensive care liaison nurse, or intensive care nurse consultant (ICNC). This service tends to be more pre-emptive in providing follow-up of ICU discharges and routine ward referrals, although ICNCs also participate in MET reviews. 7, 8
Several problems have been observed in mature MET services in the Australian setting, including increasing case load, 9
In April 2020, we introduced a critical care outreach physician (CCOP) to provide oversight for both the ICNC and MET services. The purpose of this study was to outline the interventions provided by the role and the perceptions of the role by clinical staff involved in the MET and ICNC service.
Ethics approvalEthics approval was obtained for the collection of data related to the introduction of the role (Audit/20/Austin/23) as well as for the conduct of the survey of clinical staff associated with the role (RiskmanQ No. 39692).
Austin Health is a large teaching hospital in the north of Melbourne which has more than 80 000 admissions per year, about 26 000 of which are multiday stays. The MET is staffed by a dedicated ICU registrar and MET nurse at all times. A general medicine registrar also attends MET calls when available. In addition, there is a senior ICU nurse in the role of an ICNC from 08:00 to 18:00, 7 days per week.
Details of hospital, MET and ICNC services
During the study period, there was a senior registrar rostered 24/7 to provide senior assistance for patient assessment and transport for complex patients, as well as a rostered evening consultant to deal with potential coronavirus disease 2019 (COVID-19) referrals. Between 1 July 2018 and 30 June 2019, there were 3836 MET calls, 3250 ICNC reviews, 343 Respond Blue calls, at least 200 pre-emptive ward reviews, and 23 patient and carer escalation (PACE) calls.
The details of the CCOP role and daily schedule were developed in consultation with the ICU consultant group (Online Appendix, table 1) and were outlined in an orientation handbook. The stated aims for the role were prospectively defined (Online Appendix, table 2) and the study was registered prospectively on the Australian and New Zealand Clinical Trials Registry (ACTRN12620000357954). The service operated from Monday to Friday between 08:00 and 18:00.
Details of the CCOP role
The nature of the role and timing of the outcome assessment was modified due to the emergence of the COVID-19 pandemic. An additional role of the CCOP included the need to liaise with clinicians caring for patients with confirmed or suspected COVID-19 infection (Online Appendix, table 1).
The a priori aims of the role were to:
- improve the timeliness of assessment of admission of patients from the emergency department (ED) to the ICU;
- assist with the triage of COVID-19 patients potentially needing ICU;
- provide oversight and support for the MET and ICNC services;
- provide an organisational awareness of the most at-risk patients in the hospital; and
- coordinate all ICU referrals.