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Critical Care Outreach Service

The Critical Care Outreach Service (CCOS) is a nurse-led service that supports ward nurses and doctors who are caring for acutely ill in-patients. CCOS nurses are all highly experienced, senior Critical Care trained nurses who have also undergone advanced training in patient examination and diagnostics. We take patient referrals throughout the 24 hour period, 365 days of the year.

CCOS serves the adult in-patient population on the Leighton Hospital site of Mid Cheshire NHS Foundation Trust, including maternity inpatients. All of Leighton’s adult inpatients have their vital signs monitored using an “Early Warning Score” system, (EWS). The EWS system helps staff to recognise quickly if a patient’s condition changes or deteriorates. At Leighton we use EWS to “trigger” timely patient reviews, by prompting staff to call doctors and CCOS to assess acutely unwell / deteriorating patients.

The purpose of CCOS is to:

  • Assess acutely ill / deteriorating patients on wards, and advise the patient’s team on monitoring, investigations and management plans. The aim is to stabilise and improve patients at ward level and so avoid the need for admission to Critical Care. This is the case for the vast majority of cases referred to CCOS.


  • Ensure timely referral and admission to a Critical Care bed for those patients who require a higher level of monitoring or support than can be provided at general ward level.

  • Follow up patients who have been transferred from Critical Care to ward areas. Whilst many patients have little or no memory of their Critical Care stay, many also have some anxiety when they have improved and are ready for transfer to a general ward. Critical Care Follow-up promotes a seamless transition between Critical Care and ward areas and gives opportunities for CCOS staff to assess patients’ progress both physically and emotionally. During a CCOS follow-up visit, staff have the opportunity to spend time talking to the patient about their recent Critical Care stay. This allows the staff not only to make sure that the patient is making progress with their recovery but that the patient has an understanding of why he / she was admitted to Critical Care and what treatment they received to get them better.

  • Share our knowledge and skills with ward staff, both at the bedside and through formal education programmes within the Trust. We provide training to nurses, allied health professionals and junior doctors, with an emphasis on subjects related to the acutely ill patient and tracheostomy care.

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