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Reflection on Mobile Phone

Patient and Family Activated RRS





Mandy Odell


Patient and relative activated Critical Care Outreach (CCO) is a relatively new initiative in the UK, first introduced at the Royal Berkshire NHS Hospital in 2009. Inspired by the University of Pittsburgh’s ‘Condition (H)elp’ and the tireless work of mothers who have lost their children in avoidable hospital incidents, patients and relatives can now directly contact the CCO team if they have concerns about their loved ones.

Sorrel King

If I would have been able to call a rapid response team, I believe Josie would be here today

Patient with Healthcare Nurse

Helen Haskell

has not a shred of doubt that a rapid response team would have saved her son

Mobile Phone

Paula Stevenson 

Hayley's death in 2009 was predictable and preventable. The best way to prevent this happening again is to set up a patient and family activated RRS

A Call 4 Concern (C4C) service review published in 2019 outlined the main issues with introducing such a service, and some of the findings from reviewing the C4C referrals. 

Why do we need a C4C service? We are all subject to many pressures at work that might mean we inadvertently overlook or misinterpret the signs from a deteriorating patient. There is a growing body of evidence that highlights some of those issues including: workload pressures, professional culture, ego, ward culture, lack of knowledge, differing opinions and inter-professional tensions. A C4C service can help to mitigate some of these problems.


Perceptions of the Critical Care Outreach Service

A staff survey at Royal Berkshire NHS Foundation Trust found that nurses believed that Critical Care Outreach empowered patients, families and nurses as well as providing urgent around the-clock care for patients.  Here is a poster describing these survey results:     

Here are some representative comments from that work:

Image by Alexander Grey

Dr Mandy Odell
ICU Nurse Consultant 

"Call 4 Concern© at RBH has been particularly useful for patients with chronic illnesses requiring repeat attendances to hospital and patients being stepped down to ward level care from intensive care.

It has regularly alerted the clinical team to problems they were unaware of and has avoided many complaints. the high level of retention and job satisfaction within the RBH outreach team demonstrates that far from being a burden to operate, this direct communication works for both staff and patients."

Dr Ian Rechner
ICU Consultant

It is a good idea to have C4C. It allows early detection of problems which are easier to sort out, compared to when the patient is really sick

Tim Parke
ICU Consultant

It is very reassuring to patients and families when they leave ICU and go to the ward to know they can call Outreach direct. For me, as an ICU consultant, this is a major advantage when we are planning ICU discharge. 

It establishes early contact of Outreach with patients and families and makes subsequent discussions easier and more timely.

It empowers the outreach team to speak to ward staff and the relevant medical staff about the concerns.

It provides better patient care.

It has no effect on ICU workload.

I could add I used the service myself years ago when my daughter was a medical outlier. She didn’t need an ICU referral and I didn’t want one. I just wanted to know my concerns were being listened to by someone experienced and who could raise them with the medical team.  

C4C is thus a significant improvement to the service which Outreach provides and I would recommend it unreservedly

Testimonials from patients

Here are two videos describing the patient experience and why having patient and family notification is so important.

Alison C4C

Alison C4C

Play Video
Richard C4C

Richard C4C

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