The shift begins at 08.15 when I receive hand over from the night critical care medical team who will update me on the progress of our patients and inform me of any new referrals. I then discuss the critical care bed state with the Nurse in Charge and prioritise patient workload. Occasionally I have other professionals shadowing me to gain work experience such as junior doctors, nurses and medical students. Before seeing patients I would spend some time explaining the role of the Outreach team and discussing any learning objectives and how we can achieve them.

I receive referrals from any health professional with direct patient care mainly from nurses, doctors and physiotherapists. Ward staff use a National Early Warning System (NEWS) based on the bedside “observations” such as pulse, blood pressure and temperature to help determine how sick a patient is and whether some assistance from critical care is required. The ward staff use a hand-held iPod device to input the observations, software on the iPod then gives the staff a pathway to follow. The NEWS system is effective in ensuring patients receive prompt medical treatment based on the severity of illness.

Once I have clinically assessed a patient I will then make a treatment and monitoring plan for the ward staff to follow. In the event of a patient requiring urgent admission to critical care, operating theatre or emergency scan, I will provide any required monitoring equipment and escort the patient ensuring their safety is maintained. When able, I will make time to explain to the patient and their relatives about the ICU environment and what treatments to expect.

An integral part of my role is visiting patients recently discharged from ICU, it is recognised that many patients and their relatives find the experience of being in ICU both physically and psychologically traumatic. I spend time with the patients asking them about their experiences in ICU, sometimes I am able to alleviate anxieties or “make sense” of bad dreams or simply clarify why they needed ICU. Furthermore I can give the ward staff advice on any care issues related to the ICU stay and ensure that ICU medical plans are carried forward on the ward.

My shift finishes at 20.15 when I hand over my list of patients to the night medical and nursing teams, at this time I can highlight any patients likely to deteriorate and request a senior nursing or medical night time review if required.