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Call 4 Concern

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Call 4 Concern is an initiative started by Critical Care Outreach Nurse Consultant,  Mandy Odell.

Relatives/carers know our patients best - they notice the subtle signs of deterioration in their loved one.   Families and carers are now able to refer straight to the Critical care outreach team directly if they feel that care has not been escalated.

Want to set up a call for concern initiative in your Trust?  Need some support?  Are you a relative that would like it in your Trust?

Leave comments below -


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When my daughter Jasmine was given Methylprednisolone unsafely in 2011, when she was already Hypertensive before being given the drug, unbeknownst to me, safety guidelines for giving the drug (to monitor BP) were not followed. 

She developed symptoms that were very alarming to me. I was certain she was in distress and as time went on she developed a facial palsy (as I described as 'a strange shaped mouth' ) strange movement of her limbs and slurred speech.

She was in the care of a nursing team and a very junior doctor who mistook her initial distress as 'hyperactivity' in response to steroids. This initial misdiagnosis then 'remained' despite her progressing symptoms, and my repeated attempts to get somebody to 'do something' to alleviate her distress. Conversations with a senior on call clinician described a hyperactive child whose mother is asking for sedation due to the Childs distress. This did not convey a sense of urgency for a review. 

By the time the senior clinician arrived Jasmine was seizing. At that time, once it was established BP had not been monitored and the current BP was measured, a Methyl Prednisolone induced Hypertensive Crisis was suspected. Jasmine had to be transferred to PICU.

There are many stories, like mine, where parents are on a ward with a deteriorating child, who are alarmed, and frightened, but have no power to escalate their own Childs care. Was I at home and Jasmine presented like that, I am certain I would have rushed her to A&E myself or called an ambulance. On the ward, I had to rely on the nurses and junior doctor to do this for me. For whatever the reasons were, and there were many (I do no blame them as individuals for what happened) their judgement that day was wrong. 

I firmly believe Patient Activated Call4Concern should be provided in every trust.  Why should parents / patients  be disempowered from escalating care themselves once their child / they become an inpatient. 

I am aware that what evidence there is on this subject demonstrates it is not abused or used inappropriately, it has avoided serious incidents that likely would have otherwise occurred, and every call provides the trust with insight of some sort to help with patient safety improvement. 





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Great to find this page as we are just planning our Call 4 Concern journey and keen to learn from the experience of others. I have already had a fabulously informative and inspirational chat with Karin Gerber (thanks!) at the Royal Berkshire but am very keen on hearing from those who have started more recently. At the moment, I am proposing a pilot with the critical care follow up patients and then evaluating before further roll out. Colleagues are already concerned about extra workload or getting stuck with 'difficult' patients/families- our clientele can be challenging at the best of times! So, any hints, tips, reassurances are gratefully received. Many thanks in advance, Sarah

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@Emma Richardson has just started C4C in the smaller of our Trusts in Brighton.  We started off at the smaller one, just in case we got bombarded with calls.  We started in July.


Emma can give you more information on how many calls we had.  Its around 10 since we started.  We also give out our leaflets to our follow up group.

We have not been stuck with 'difficult' patients at all, they have all been great calls.

Happy to discuss more if you have anything specific to ask


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Sorry I have not been keeping up with the hub recently.... busy busy busy! ?

Better late than never, but I wanted to share our We're Listening (aka Call for Concern) Leaflet with you all.  It's now fully published and already displayed in multiple areas!! ? (sigh of relief!!) (SEE ATTACHED).

The plan is for it to be displayed in all hospital areas, but it's taking some time to get the news out and ask departments to order and display (they're free from Office Depot).

I have recently started an all hospital audit which is helping to get the word out. Also our Outreach Team are trialing email footers to spread word of things that we feel are important.  For those of you who have not seen them, we also write a regular joint CCOT/HOOH newsletters.

An artist helped develop our 'ear' logo which we are trying to use on much of our stationary/correspondents with the hope of the logo becoming associated with the Outreach (CCOT) Team and ultimately our We're Listening service.

All ideas are very welcome on how to improve staff awareness of our service further. ☺️

For those that don't know, we have had a Call for Concern service in place in our Trust for many years, but have given it a huge revamp over the last couple of years....mainly to increase staff and patient/visitor awareness and understanding of it so it can be used effectively.

I keep a record of all calls received.  More recently, I have attempted to collect the same data as @Mandy Odell used in her review article and will continue with this going forward.  So far, our data is very comparable!!

Hope you are all keeping well.

Speak soon



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@Danielle Haupt @Mandy Odell @Claire Cox @gerberk @Emma Richardson

Hi all, 

I am in need of some help. We are recommencing our Call 4 Concern proposal and have begun by presenting a proposal paper. Already we have concerns raised by the ICU consultants about the impact C4C will have on their workload. We have presented the data obtained from Royal Berkshire showing the CCOT workload is increased by only 1% and out of 532 (ish) patients, only 6 required higher levels of care. They are concerned that the service will generate more referrals to them for decision making about treatment escalations and family members will expect ICU involvement and admission. We will have the data comparison with our current activity to demonstrate how little activity it will generate for us as a service (anticipated 1 patient a month C4C) and less so for them. 
I wondered whether we could obtain some testimonials from ICU teams from your hospitals to reinforce this. 

I am afraid without this, we will probably not gain their support. 

Hope you can help us at all. 

My email - kirsty.wood9@nhs.net

Thanks. 🙂 

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Hi all I could do with some feedback from Trusts that have Call 4 Concern in place. I am hoping to role it out in the coming months within the trust I work for but understandable have some concerned colleagues that believe they are going to be dealing with complaints and unnecessary referrals on top of a already very busy outreach service (at times). 

If people could send me feedback be it good or bad for me to present to the rest of the team to hopefully get them more on board I would be extremely grateful.



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