Unreliable critical-care outreach for deteriorating patients
First to latest report 22 Aug 2014 — 16 Jun 2025
Reports that mention this concern
7
Times this concern has been raised
7
Stated actions linked to this concern
10
What this concern includes
Includes only assertions that directly instantiate the manually reviewed condition ‘Unreliable critical-care outreach for deteriorating patients’ and satisfy this evidence boundary: Three distinct reports directly support outreach-team non-attendance in emergency departments, limited outreach authority causing treatment delay, and outreach unavailability because of staffing. Excludes general ICU escalation, doctor-to-doctor discussion and specialty-training assertions; retire position 250 and move its shared outreach assertion here so it is counted once.
What is not included
Excludes general hospital staffing, training or capacity deficiencies not specifically tied to critical-care capability for deteriorating patients.
Excludes critical-care bed-capacity shortages where the concern is availability of beds rather than critical-care expertise, escalation or outreach support.
Excludes failures in definitive treatment after appropriate critical-care input has been obtained.
Excludes unrelated emergency-response, referral or clinical-management failures without a material critical-care capability or escalation component.
Excludes manifestations outside the manually reviewed boundary: Three distinct reports directly support outreach-team non-attendance in emergency departments, limited outreach authority causing treatment delay, and outreach unavailability because of staffing. Excludes general ICU escalation, doctor-to-doctor discussion and specialty-training assertions; retire position 250 and move its shared outreach assertion here so it is counted once.
Trends
Reports over time
Reports mentioning this concern, over time
Reports about this concern issued each year.
* 2026 is projected from reports observed to 7 Sep 2026.
Most frequent recipients
Most frequent recipients
Reports about this concern sent to each recipient.
Barts Health NHS Trust1
Bedfordshire Hospitals NHS Foundation Trust1
Great Western Hospitals NHS Foundation Trust1
Mid and South Essex NHS Foundation Trust1
NHS England1
Royal College of Obstetricians and Gynaecologists1
Royal Sussex County Hospital1
Tameside and Glossop Integrated Care NHS Foundation Trust1
Tameside General Hospital1
University Hospitals Sussex NHS Foundation Trust1
NHS trust6
Healthcare site2
Executive non-departmental public body1
Health professional body1
Reports and published responses 7 reports
See individual reports that have raised this concern, and the actions taken in response
East London
Concerns raised1
Failure of the Critical Care Outreach Team to attend A&E for deteriorating patients
This report raised 8 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
Barts Health NHS Trust
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.2
Barts Health NHS Trust
CCOT cannot currently review acutely unwell, undifferentiated Emergency Department patients because it lacks the required skills and resources.
Unable to actThe respondent said that a constraint prevented them from taking the relevant action.
Barts Health NHS Trust
A critical care in-reach registrar with consultant intensivist access provides responsive Emergency Department support, although it does not replace full CCOT presence.
Existing arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Essex
Concerns raised1
Delays in escalating deteriorating maternity patients for senior and critical care review
This report raised 15 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked responses
Mid and South Essex NHS Foundation Trust
Royal College of Obstetricians and Gynaecologists
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.8
Royal College of Obstetricians and Gynaecologists
Provide guidance on preventing and managing postpartum haemorrhage, including clinical assessment, monitoring, escalation and multidisciplinary response.
Royal College of Obstetricians and Gynaecologists
Provide guidance defining circumstances requiring consultant attendance in acute obstetric and gynaecological care, including maternal collapse and major haemorrhage.
Mid and South Essex NHS Foundation Trust
Teach and practise SBAR escalation during annual multidisciplinary PROMPT training.
Mid and South Essex NHS Foundation Trust
Launch the RCOG escalation toolkit, including AID language, conflict-resolution teaching and team-of-shift handover practices.
Mid and South Essex NHS Foundation Trust
Implement the OBS UK obstetric bleeding care bundle covering risk assessment, quantitative blood-loss measurement, escalation, and rapid clotting tests.
Mid and South Essex NHS Foundation Trust
Implement the national MEWS observation package and escalation policy, including trigger-team referral and mandatory maternity-inpatient use.
Mid and South Essex NHS Foundation Trust
Embed deterioration recognition, concealed-bleeding assessment and escalation training in PROMPT, induction, local teaching, drills and written staff communications.
Mid and South Essex NHS Foundation Trust
Adopt a rota requiring junior registrars to pair with senior registrars and establish supervision and risk-mitigation arrangements when the intended skill mix is unavailable.
Manchester South
Concerns raised1
Unavailability and insufficient capacity of the Critical Care Outreach team
This report raised 6 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked responses
NHS England
Tameside and Glossop Integrated Care NHS Foundation Trust
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
Tameside and Glossop Integrated Care NHS Foundation Trust
Maintain a 24-hour, seven-day MERIT service staffed by senior anaesthetic clinicians to provide emergency critical-care support.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.3
NHS England
The concerns fall under the Trust’s remit rather than NHS England’s functions.
Outside remitThe respondent said that this matter was outside its role or authority.
NHS England
The Trust is the appropriate organisation to respond, with the Greater Manchester Integrated Care Board responsible for commissioning.
Redirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Tameside and Glossop Integrated Care NHS Foundation Trust
Existing outreach absence procedures, staffing oversight and MERIT support provided alternative safeguards when an outreach practitioner was redeployed.
Existing arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Bedfordshire and Luton
Concerns raised1
Limited critical care outreach authority and initial medical response causing potential delays in life-saving measures
This report raised 4 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked response
The Trust
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
The Trust
Operate a multidisciplinary critical care outreach team with trained staff, authority to develop treatment plans, medical access and consultant review of referred patients.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.2
The Trust
A doctor is not required for the critical care outreach team’s initial response because its multidisciplinary model complies with national standards.
Existing arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
The Trust
Critical care outreach nurses do not request CT scans; scan requests are escalated to an appropriate doctor.
Redirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Manchester South
Concerns raised1
Failure to explore alternative escalation routes when ICU outreach is unavailable
This report raised 12 other concerns. They are not shown here because they do not form part of this recurring concern.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
Wiltshire and Swindon
Concerns raised1
Failure to empower nursing staff to refer critically ill patients to the Critical Care Outreach Team
This report raised 4 other concerns. They are not shown here because they do not form part of this recurring concern.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
Brighton and Hove
Concerns raised1
Failure to refer patients to the Critical Care Outreach Team at required NEWS thresholds
This report raised 8 other concerns. They are not shown here because they do not form part of this recurring concern.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
Actions and positions describe what organisations say in published responses. Implementation is not independently verified.
Actions and positions describe what organisations say in published responses. Implementation is not independently verified.