The CCO-RE study
Research type
Research Study
Full title
Characterising the work of Critical Care Outreach Nurses using Resilience Engineering - The CCO-RE study.
IRAS ID
327108
Contact name
Amy Silver
Contact email
Sponsor organisation
City, University of London
Duration of Study in the UK
0 years, 10 months, 30 days
Research summary
Summary of Research
There is a nationwide effort to improve how hospitals identify, respond to, and care for patients who become critically ill during their hospital admission. Rapid Response Systems (RRSs) are present in many hospitals across the UK. The purpose of the RRS is to help clinical staff to recognise patients who are deteriorating, and activate a time-critical response from the right person or team. In the UK, this response is the remit of Critical Care Outreach (CCO) nurses.
CCO nurses are clinical experts with specialised knowledge in detecting, managing, and caring for critically ill patients. It is broadly acknowledged that CCO nurses provide a valuable service. However it has been difficult to evidence how CCO nurses help keep patients safe in hospitals. This may be due to variation between teams and hospitals, a lack of randomised controlled trials, and a historical focus on measuring quantitative outcomes like illness and death rates.
The study proposes to use a theoretical resilience engineering model to as a lens to understand and analyse the activities and behaviours of CCO nurses, and examine how CCO nurses uphold and maintain the response arm of the RRS.
Participants in the study will be CCO nurses working in a large NHS hospital in the UK. The researcher will spend eight weeks observing and interviewing the nurses to understand how they respond to clinical needs, anticipate challenges, and adjust their approach during periods of high activity to continue to meet the needs of unwell patients.
Funding for the study is provided by a personal award, through the National Institute of Health Research (NIHR) Pre-Doctoral Academic Fellowship program.
Summary of Results
When someone is in hospital, their condition can sometimes get worse. Many hospitals in the United Kingdom (UK) have systems in place to support hospital staff to know when patients on wards are becoming sicker, and to get help quickly. These are called Rapid Response Systems (RRS).
In the UK, Critical Care Outreach Teams (CCOTs) are one part of Rapid Response Systems. CCOTs are specialist teams of nurses who have advanced knowledge and skills in looking after very sick patients. When someone’s health gets worse, staff in hospital can call upon a Critical Care Outreach (CCO) nurse to help them care for that person.
CCO nurses come to every part of a hospital – they do not focus on just one ward or area. They give expert care to patients who are unwell and may need urgent treatment. For example, if a patient's blood pressure is very low, a CCO nurse may be called to help.Evidence shows that CCO nurses are very important to keeping patients safe outside the Intensive Care Unit (ICU). However, it has been difficult to show how CCO nurses help keep patients safe in hospitals, and how they help the RRS to work well overall.
To understand this in more detail, we did a research study. We wanted to know more about the activities and work done by CCO nurses. We also wanted to understand more about how CCO nurses support the RRS to carrying on working when there is high demand or pressure.
We did our research using an approach called ‘resilient healthcare’. Resilient healthcare looks at how healthcare systems cope under pressure and how staff adapt to these pressures. We involved a small group of patients and carers, who helped us decide how to do our research and what to focus on.
The research study was completed in one large teaching hospital in the UK with a CCO Team. We collected information over a period of eight weeks. Ten CCO nurses took part. We watched each CCO nurse doing their everyday work, then we interviewed them. Afterwards, we analysed all the collected data, using a resilient healthcare approach.
The information showed that CCO nursing work is very complicated. The CCO nurses faced lots of challenges. The nurses had to take lots of different steps to make sure they could keep providing care quickly across the hospital. This was especially hard at times when lots of different patients needed urgent care from the CCO Team.
CCO nurses thought ahead to stop problems before they happened. They helped different hospital teams communicate to make sure patients got the right care at the right time. They often went beyond their official role to make sure patients didn’t miss out on treatment or services.
Our study provides new information about the work done by CCO nurses, and how they help keep patients safe in hospitals. The findings may support discussions about the importance of CCO nurses, or similar teams, in the UK and other countries. We also hope to carry out further research across multiple hospitals, to better understand what CCOTs do and how they work within complex healthcare systems.REC name
East of Scotland Research Ethics Service REC 2
REC reference
23/ES/0028
Date of REC Opinion
4 Aug 2023
REC opinion
Favourable Opinion