Abstract :

This audit focused on the Critical Care Outreach Team (CCOT) services and their impact on patient care in the hospital. The audit identified problems such as inadequate communication, coordination of care, and information exchange between ICU and general ward professionals, leading to increased readmission rates and mortality. It also highlighted the need for better recognition and initiation of treatment for deteriorating patients in step-down wards and inconsistencies in tracking and triggering systems. Significant improvements were achieved through a comprehensive plan and actions, including training sessions, data collection, and analysis. The CCOT successfully addressed significant and minor complaints, reducing readmission rates and code blue calls. Implementing CCOT services improved communication, enriched ward nurses’ skills, increased patient and attendee satisfaction, and enhanced the support ecosystem among ward staff. The results demonstrated the effectiveness of CCOT in providing high-quality care, leading to increased revenue for the hospital.

Organization Profile

Shri. B. Nagi Reddi, the recipient of the esteemed Dada Saheb Phalke Award for his invaluable contributions to the Indian film industry, was a genuinely versatile individual. He founded Vijaya Vauhini Studios, a prominent hub for film production in India. Additionally, he established Prasad Process, one of the country’s largest printing presses, which published beloved children’s magazines like “Chandamama,” cherished by millions of readers today. Shri. B. Nagi Reddi exemplified dynamism and a relentless pursuit of excellence. Despite his numerous achievements and honors, his genuine aspiration was to provide affordable medical services to society.

1972 he transformed his vision into reality by establishing Vijaya Hospital in Chennai. It was one of the pioneering multi-speciality hospitals in the city, starting with 30 beds. Today, under the umbrella of Vijaya Medical and Educational Trust (VMET), the hospital has expanded to over 750 beds. The VMET includes Vijaya Hospital (VH), Vijaya Health Centre (VHC), Vijaya Heart Foundation (VHF), and Vijaya Eye Foundation.

Introduction

Critical Care Outreach (CCOT) Services are a vital component of a comprehensive hospital-wide approach to enhancing the early detection and management of patients experiencing clinical deterioration in the general wards. This service, led by nurses, operates directly at the patient’s bedside. By implementing early warning indicators, the CCOT Services facilitate healthcare teams in promptly identifying deteriorating patients and ensuring an appropriate and timely response to their needs. The hospital’s clinical audit committee team identifies projects requiring prioritization, focusing on initiatives to enhance the quality of care. These projects are then submitted to the management for prompt approval.

Some of the identified problems were:

• Inadequate communication, coordination of care, and information exchange between professionals in the Intensive Care Unit (ICU) and general ward contribute to higher rates of readmission to the ICU and mortality.
• There is a deficiency in recognizing and initiating treatment for patients experiencing deterioration in step-down wards.
• The practice of tracking and triggering systems lacks consistency.

The factors that helped in the identification of these issues were:

• Due to an increase in code blue calls and readmission rates from the step-down wards to the Intensive Care Unit (ICU), an audit was conducted for a period of January 2021 to October 2021, with a minimum observation time of 48 hours.
• The total number of code blue calls between January 2021 and October 2021 was 64. Of these, 37 calls (57%) originated from the step-down wards.
• Among the 2,154 patients transferred from the ICU during the pre-CCOT period (January 2021 to October 2021), 50 (2.3%) were readmitted to the ICU from the step-down wards within 48 hours.
• The frequency of code blue calls and related events during this period raised concerns about the situation.

Following are the actions that need to be taken to maintain any of the improvements made:

• Implement strict adherence to ICU discharge criteria for patients transitioning to the ward.
• Establish the Critical Care team’s regular monitoring of step-down ward patients for 48 hours.
• Address and rectify any issues or complaints identified by the Critical Care Outreach Team (CCOT) during bedside discussions with primary consultants in the ward.
• Conduct reaudits every six months to evaluate the effectiveness of CCOT services.
• Recognizing the impressive work of the CCOT, plan to expand the Critical Care Outreach Team’s scope to include all patients in the wards requiring close monitoring, thereby reducing the occurrence of code blue calls.
• Train staff nurses to ensure consistency in the Early Warning Scores (EWS) practice.

Furthermore, implementation of the Critical Care Outreach Team has resulted in the following:

• By focusing on strengthening the continuity of patient care beyond the adult Intensive Care Unit (ICU), the Critical Care Outreach Team (CCOT) has made significant strides. Their diligent observations have allowed them to address major complaints (totaling 121) and minor complaints (totaling 131) directly in the step-down wards, resulting in a notable reduction in readmission rates and code blue calls for patients. This proactive approach has not only improved patient outcomes but has also empowered the team to take charge of delivering efficient and effective care. The emphasis on enhancing the quality of care has yielded positive results, leading to increased revenue for the hospital.
• The implementation of the Critical Care Outreach Team (CCOT) has resulted in improved communication between the team and treating consultants, facilitating effective collaboration. Additionally, it has provided ward nurses with valuable knowledge and skills to manage critically ill patients. This has led to increased satisfaction levels among patients and their attenders. Moreover, the presence of a supportive ecosystem among ward staff members has been established. The consultants express satisfaction with the timely updates on patients, ensuring comprehensive care and prompt decision-making.
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