9. Outreach

Introduction

One of the approaches to the recognition and management of seriously ill patients has been the development of early warning systems and outreach services. This was proposed as a solution in England by the Department of Health in 2000 ¹⁰ and has been endorsed by the Royal College of Physicians in 2002 ⁷.

It is not clear how outreach services should be organised and there are a number of different models of outreach care ^25,36. The main differences are the trigger that prompts review by an outreach service, the availability of the outreach service throughout the 24 hour period and the composition of the outreach team that responds to the trigger. It is unlikely that the trigger used is of great importance, so long as it
is suitably sensitive and specific, but it is of no use highlighting deteriorating patients through an early warning system if there is no link to a robust and effective team response and critical care service.