COVID-19: Brief service considerations for critical care outreach and rapid response teams 

Please note this is for guidance only and the latest Public Health England/NHS England advice and guidance should be adhered to. This aims to provide some practical considerations to help CCOT deal with the public health outbreak, maintain continuity of care and support at risk, deteriorating and critically ill patients. CCOT are unique in that they work across the entire hospital and it is therefore a real risk for these teams to cross-contaminate. 

You may wish to consider:

 Separating teams into ‘potentially contaminated’/’uncontaminated’ staff so that one half of the team sees all patients with respiratory illness/fever and the remaining see other patients (individual staff needs such as caring responsibilities at home may be important considerations here)

• Assessing or advising from afar (>2metres), using clinical cues, physiological data and visual inspection wherever possible in the case of patients with respiratory illness/fever 
  
• Planning simulation exercises of donning and doffing, videoing where possible, to assess and practice techniques and to lessen risk of cross-contamination  
  
•  Timing how long each transfer using full PPE takes to allow teams to ensure early planning/transfer of deteriorating, suspected COVIC-19 patients
  
• Preparing to support and implement early discharge plans for ICU patients who may not be ward-ready, and working with ward staff to enact these
  
• Preparing for critical care surge criteria planning (as per local, network or national plans) to consider how to staff/support staff if critical care beds outside ICU are implemented, or if CCOT staff are required to work in ICUs
  
• Reviewing staff competencies in relation to map those with recent Step 3 competencies (CC3N), especially as some CCOT staff may not have worked in ICU for a long time.
  
• Preparing intra and cross-division plans, such as working with anaesthetics, paediatrics, maternity services to support critically ill patients and support the wider workforce, which may be depleted
  
• Reviewing ICU and critical care bed triage criteria, in the event of reverse triage scenarios being implemented, CCOT are likely to be highly important in supporting and initiating decisions to limit medical treatment, in conjunction with the medical team in charge of the patient
• Preparing a plan via occupational health/local staff support to support staff and encourage resilience; many staff will work additional hours during these pressures and may be at increased risk of burnout and moral injury.    

LINKS AND RESOURCES

• NICE COVID 19 Rapid Guideline Critical Care
• Critical Care Admission  Decision Algorithm
• Speciality guide COVID 19 for ICU v1 16032020
• Specialty guide COVID 19 for surgery v1 16032020
• COVID -19 - Principles for nurse staffing in critical care surge
• Covid 19 Aniarti to Efccna
• COVID-19 Non-Critical Care Staff in Critical Care - Best Practice Guidelines - Final
• Decision making for treatment escalation
• Critical Care Decission Support form
  
• FICM EoL_care summary