CALL 4 CONCERN ©
“EVERYONE HAS THE RIGHT TO SAVE THEIR OWN LIFE”
by Mandy Odell
Patient and relative activated Critical Care Outreach (CCO) is a relatively new initiative in the UK, first introduced at the Royal Berkshire NHS FT in 2009. Inspired by the University of Pittsburgh’s ‘Condition (H)elp’ and the tireless work of mothers who have lost their children in avoidable hospital incidents, patients and relatives can now directly contact the CCO team if they have concerns about their loved ones.
‘If I would have been able to call a rapid response team, I believe Josie would be here today,’ – Sorrel King.
Helen (Haskell) has “not a shred of doubt” that a rapid response team would have saved her son.
Paula Stevenson – ‘Hayley’s death in 2009 was predictable and preventable. The best way to prevent this happening again is to set up a patient and family activated’.
A Call 4 Concern (C4C) service review published in 2019 outlined the main issues with introducing such a service, and some of the findings from reviewing the C4C referrals.
Why do we need a C4C service? We are all subject to many pressures at work that might mean we inadvertently overlook or misinterpret the signs from a deteriorating patient. There is a growing body of evidence that highlights some of those issues including: workload pressures, professional culture, ego, ward culture, lack of knowledge, differing opinions and inter-professional tensions. A C4C service can help to mitigate some of these problems.
Perceptions of the Critical Care Outreach Service
A staff survey at Royal Berkshire NHS Foundation Trust found that nurses believed that Critical Care Outreach empowered patients, families and nurses as well as providing urgent around the-clock care for patients. Here is a poster describing these survey results. Here are some representative comments from that work:
“Call 4 Concern© at RBH has been particularly useful for patients with chronic illnesses requiring repeat attendances to hospital and patients being stepped down to ward level care from intensive care.
It has regularly alerted the clinical team to problems they were unaware of and has avoided many complaints. the high level of retention and job satisfaction within the RBH outreach team demonstrates that far from being a burden to operate, this direct communication works for both staff and patients.”
“It is a good idea to have C4C. It allows early detection of problems which are easier to sort out, compared to when the patient is really sick”.
–Ian Rechner, ICU Consultant
“It is very reassuring to patients and families when they leave ICU and go to the ward to know they can call Outreach direct. For me, as an ICU consultant, this is a major advantage when we are planning ICU discharge.
It establishes early contact of Outreach with patients and families and makes subsequent discussions easier and more timely.
It empowers the outreach team to speak to ward staff and the relevant medical staff about the concerns.
It provides better patient care.
It has no effect on ICU workload.
I could add I used the service myself years ago when my daughter was a medical outlier. She didn’t need an ICU referral and I didn’t want one. I just wanted to know my concerns were being listened to by someone experienced and who could raise them with the medical team.
C4C is thus a significant improvement to the service which Outreach provides and I would recommend it unreservedly”.
–Tim Parke, ICU Consultant
Testimonials from patients.
Here are two videos describing the patient experience and why having patient and family notification is so important.
Additional materials to help you get started.
Here are some of the cards and materials we developed at the Royal Berkshire hospital for your reference. Click the phrases below for downloadable material. Please use these as a reference for materials you may want to develop at you’re your own institution. If you do not change the text, kindly credit the developers by adding this copyright: ©Royal Berkshire NHS FT 2010.
Publications and links
Odell M (2019). Patient- and relative-activated critical care outreach: a 7-year service review. British Journal of Nursing; 28(2):116-121. DOI: 10.12968/bjon.2019.28.2.116
Odell M, Gerber K, Gager M (2010). Call 4 Concern: patient and relative activated critical care outreach. British Journal of Nursing; 19(22):1390-5. DOI: 10.12968/bjon.2010.19.22.1390
Williams G et al (2022). A practical approach to establishing a critical care outreach service: An expert panel research design. Australian Critical Care. DOI: 10.1016/j.aucc.2022.01.008