“The Critical Care Outreach (CCO) programme is a significant development in how we support patients at risk of deterioration – it has improved patient outcomes, strengthened clinical decision-making, and enhanced collaboration across multidisciplinary teams,” according to Una Cardin, Director of Nursing at Letterkenny University Hospital, (LUH), commenting on the vital role the CCO programme at the hospital.
Established in March 2023 and led by two Advanced Nurse Practitioners (ANPs), the service supports patients who are identified as being at high risk of clinical deterioration, including those with changes in respiratory rate, heart rate, blood pressure or level of consciousness.
Una adds: “The programme plays a pivotal role in improving the early detection and management of deteriorating patients, strengthening patient care and safety and providing vital support to clinical teams across the hospital. The expertise and leadership of the ANP team has been central to its success and ongoing development.”
Since its introduction, activity has steadily risen, with 480 episodes of care recorded in 2023, increasing to 782 in 2024, and 992 in 2025. In the first five months of 2026, 414 episodes of care have already been completed. To date, 1071 patients have been supported through ICU-to-ward transition.
The programme has also delivered measurable improvements in patient outcomes, including a 50% reduction in unplanned ICU readmissions within 48 hours of discharge and a reduction in overall hospital length of stay following ICU discharge highlighted by the Irish National ICU Audit.
Concerns of clinical deterioration can be escalated directly by the clinical team caring for the patient to the Critical Care Outreach service that prompts a timely review and targeted interventions, which include undertaking advanced a clinical assessment to prioritise care needs and acting as a link between specialist services.
A central element of the service is its ANP-led Intensive Care Unit (ICU) step-down pathway, which supports patients recovering from critical illness. This pathway ensures continuity of care following discharge from ICU, promotes safe transition to the ward environment, and maintains ongoing clinical review during recovery.
The programme also allows for urgent treatment to be initiated where appropriate, including oxygen therapy, intravenous fluids, antibiotics, and nurse prescribing. It provides real-time guidance and support to ward staff to help stabilise the patient and further provides ongoing monitoring of the patient’s condition to ensure improvement or timely escalation of care
Advocacy support is also offered to patients and their families throughout the episode of care.
The service is led by two highly experienced ANPs whose clinical backgrounds span critical care, emergency medicine, and international healthcare systems.
Gráinne Nee, ANP in Critical Care Outreach, explains that “critical care outreach gives us the ability to respond early at the bedside, work alongside ward teams in real time, and ensure patients showing signs of deterioration are assessed and escalated without delay.”
Her colleague, Lisa McHugh, ANP in Critical Care Outreach, outlines how their focus is on “ensuring patients move safely and smoothly from intensive care to the ward. We work closely with staff across the hospital to support recovery, build confidence in recognising deterioration, and strengthen overall patient safety.”
The Critical Care Outreach service operates as part of a multidisciplinary team, collaborating closely with intensive care, anaesthesia, consultant teams, ward staff, and nursing leadership. It is fully integrated into the hospital’s systems for managing the deteriorating patient.
Currently operating on a weekday basis, national guidance supports future expansion towards a 24/7 service model, which would further enhance patient safety and access to specialist critical care expertise.
The introduction and ongoing development of the CCO programme at LUH represents a significant advancement in the care of acutely unwell patients. Through early intervention, advanced clinical practice, and targeted education, the service continues to strengthen patient outcomes and support staff across the hospital.