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The UK Forum for Multi-Professional Critical Care Outreach, 
   Medical Emergency, Acute and Rapid Response Teams

Covid-19 and Outreach

  • 12 Mar 2020 10:02
    Message # 8822893

    Hi everyone,

    Has anyone written guidance for CCOT's and how they function during this pandemic? I think these teams will play a massive role in assisting Critical Care in discharging patients earlier than they normally would and also accelerating escalation decision making on the wards and having difficult conversations regarding escalation.

    Currently I am keen to protect the team and ensure they are not counted as potential 'pull-backs' for Critical Care surge escalation.

    Any thoughts? Guidance?



  • 12 Mar 2020 13:08
    Reply # 8823044 on 8822893

    Hi! Outreach are written into our critical care service's surge capacity plan. All team members are critical care trained and therefore the most appropriate to support. Completely understand about protecting outreach services and expediting discharges to the ward though. We are planning to use anaesthetic colleagues who aren't required due to elective surgery being cancelled. They don't have the skills to look after a level 3 patient on critical care, but do have skills to assess deteriorating/ follow up patients on the ward. However, will have to keep things under review!

  • 12 Mar 2020 18:02
    Reply # 8823684 on 8822893
    Anonymous member (Administrator)

    We hope to put some brief guidance out later - watch this space and twitter @ccc_outreach 

  • 13 Mar 2020 08:47
    Reply # 8824835 on 8822893
    Anonymous member (Administrator)

    Suggestions (which may change based on changing advice from PHE/NHSE and Trusts)

    Please note these are suggestions/tips only and the latest Public Health England/NHS England advice and guidance (www.nhs.uk/coronavirus and www.gov.uk/coronavirus ), and local Trust guidance should be adhered to.

    CCOT are unique in that they work across the entire hospital and it is therefore a real risk for these teams to cross-contaminate.

    • ·       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
    • ·       Pre-triage questions when taking ward/clinical area referrals (to help assess infection risk to CCOT as potential super-spreaders)
    • ·       Also see: https://www.nmc.org.uk/news/news-and-updates/how-we-will-continue-to-regulate-in-light-of-novel-coronavirus/
    • ·       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
    • ·       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)
    • ·       Consider assessing or advising from afar (>2metres), using clinical cues, physiological data and visual inspection wherever possible in the case of patients with suspected COVID-19/respiratory illness/fever
    • ·       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    
    • ·       Reviewing/familiarising with resuscitation council guidance on COVID-19; https://www.resus.org.uk/media/statements/resuscitation-council-uk-statements-on-covid-19-coronavirus-cpr-and-resuscitation/covid-community/
    • ·       https://www.gov.uk/government/publications/novel-coronavirus-2019-ncov-interim-guidance-for-first-responders/interim-guidance-for-first-responders-and-others-in-close-contact-with-symptomatic-people-with-potential-2019-ncov
    • ·       UK Critical Care Nursing Alliance (of which NOrF is part) is due to release advice imminently (www.ficm.ac.uk/ukccna)
    • ·       NHSE and NMC have also put out advice/position statement on 11.3.20 www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/joint-nm-letter-11-march-2020.pdf

  • 14 Mar 2020 10:04
    Reply # 8826690 on 8822893

    Our hospital guidelines change every day after the Daily COVID meeting and in response to NHS guidance. We have three  huddles with all the ICUs each day which CCOT attend when this is fed back, we adapt our response to this, we update the whole team using what’s app and the lead for COVID summarises  in an email daily, having more solid guidance written down gets out of date too quickly.

    We are trying to do what’s already advised above in terms of donning and doffing practice (but PPE availability is low), dirty and clean nurse, reducing interaction with patients etc The links were useful thank you. We are currently trying to keep outreach as a service but we appreciate that the need for icu staff may become too great and we will have to aid with this. Currently our focus is on supporting ward staff (with training for donning and doffing and for testing). 

    I’d be interested in specific guidance on transfers of COVID patients, with assigned roles etc if anyone had done this 

  • 14 Mar 2020 20:39
    Reply # 8827675 on 8822893

    Since my last message found these.

    would be useful to share further things as there is so much information coming from different sources it would help if relevant stuff was on here 

    2 files
  • 21 Mar 2020 12:25
    Reply # 8846637 on 8822893
    Anonymous member (Administrator)

    Dear all,

    We have set up a COVID 19 page on the NOrF website. We will try to upload resources for CCO/RRT but keeping with the national guidelines. If you have any local guidleines that you want to share, please use the forum to discuss them and upload them.

    Thank you and keep well!

  • 28 Mar 2020 08:04
    Reply # 8863661 on 8822893

    Thanks for keeping the site updated: it’s hard to keep up with all the info every day!

    In relation to the above question. We tried to keep my team together but we’ve gone from 2-3 outreach on the day and 1 outreach/3 H@N to 1 in the day and 3 at night. With a lot of staff sickness. This is because our units are surging and the need for critical care staff is so great. We try and do a lot of remote reviewing but still trying to keep some presence with the ward staff to support them. We now have a transfer team of anaesthetists and ODPs and so we can assess someone, call them to intubate and transfer to icu and we can move to the next referral. Our practice and the expectations on us changes on a daily basis. We have managed to get some positives - like finally getting TEP onto our online system and rolling out an electronic system for alerting us to the NEWS scores but it’s a very different service from 4 weeks ago, or even a week ago (London teaching hospital for context). 

  • 28 Mar 2020 08:30
    Reply # 8863680 on 8822893
    Anonymous member (Administrator)

    Hi Natasha,

    The iSRRS ( members of our board sit on this) have published a document, https://rapidresponsesystems.org/?page_id=1232 

    We also ensured a section on this exact issue was added to the national surge document which is in the process of being signed off by NHSE.

    Best wishes, Natalie (EB)


  • 29 Mar 2020 08:03
    Reply # 8864956 on 8822893

    Dear Natalie,

    Thanks - we had gone through the iSRRS document this week and it was really helpful to have a structure laid out we could compare our response to (as I was saying in a previous post, it’s hard to keep up with all the changing guidance). Our IT department has since been able to get the COVID patients identified on our NEWS alerts tool which is really useful. We are a brand new team that only went live very shortly before the pandemic started, knowing we are approaching it in line with international recommendations had given us some confidence.

    For those of you in areas less affected so far, I really recommend looking at some of the information and guidance available on resilience and psychological support for your staff - the expectations on my team are huge and varying. Also run as much sim on intubation and transfers as possible to get staff prepared. 

    Take care everyone 

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