Critical care outreach team's effect on patient outcome

Editor—The significance for the relative risk ratio, for patients surviving to discharge, between the two groups was P = 0.0452.

In relation to our readmission data, the increase in survival and increase in median length of stay before and after the introduction of the outreach team might explain the published results. After discussion with consultant colleagues we think that patients could be discharged to the ward with more confidence with the introduction of the outreach team. Therefore, the increase in length of stay in the unit was associated with patients' need for level 3 care rather than a conscious decision to keep patients in the unit for a longer period to avoid possible readmission.¹

We cannot claim the subgroups were equivalent on discharge. For some time we have been considering the utility of collecting acute physiology and chronic health evaluation (APACHE II) data on discharge from intensive care as this would help us to examine severity of illness on discharge to the ward. The table shows hospital mortality for all patients admitted to the intensive care unit. Our standardised mortality ratio for all patients admitted to intensive care eligible for mortality standardisation by APACHE II was 1.81 (95% CI 1.65 to 1.96) before the introduction of the outreach team (n = 315) and 1.38 (1.23 to 1.52) afterwards (n = 354). The difference in the ratio between the two groups implies that the critical care outreach team has had a genuine effect in reducing hospital mortality.

Table 1.

Hospital mortality. Values are numbers (percentages)

Hospital outcome	Before critical outreach team	After critical outreach team	Total
Alive	168 (48)	235 (62)	403 (55)
Dead	181 (52)	145 (38)	326 (45)
Total	349	380	729