The purpose of the study was to investigate the effects of introducing a critical care outreach service on in-hospital mortality and length of stay in a general acute hospital.Design:
A pragmatic ward-randomised trial design was used, with intervention introduced to all wards in sequence. No blinding was possible.Setting:
Sixteen adult wards in an 800-bed general hospital in the north of England.Patients and participants:
All admissions to the 16 surgical, medical and elderly care wards during 32-week study period were included (7450 patients in total, of whom 2903 were eligible for the primary comparison).Interventions:
Essential elements of the Critical Care Outreach service introduced during the study were a nurse-led team of nurses and doctors experienced in critical care, a 24-h service, emphasis on education, support and practical help for ward staff.Measurements and results:
The main outcome measures were in-hospital mortality and length of stay. Outreach intervention reduced in-hospital mortality compared with control (two-level odds ratio: 0.52 (95% CI 0.32–0.85). A possible increased length of stay associated with outreach was not fully supported by confirmatory and sensitivity analyses.Conclusions:
The study suggests outreach reduces mortality in general hospital wards. It may also increase length of stay, but our findings on this are equivocal.