Nurse-Led Outreach Program Advances Patient Safety Through Proactive Care

Faced with steadily rising occupancy and increased patient acuity, Cleveland Clinic Abu Dhabi (CCAD) was compelled to address a pressing need: a structured, highly skilled team capable of bridging the gap between critical care and acute care settings.

Determined to find a solution, the hospital created a new Critical Care Outreach Nurse Program (CCONP) aimed at identifying patient deterioration early, reducing unplanned ICU admissions and decreasing Code Blue activations — all in service of CCAD’s broader commitment to zero harm.

The turning point came when stakeholders reviewed the patterns emerging across acute care units (ACUs), explains Elizabeth Craig, RN, a critical care outreach nurse who helps lead the program.

“We were seeing a higher number of Code Blue activations and cardiopulmonary arrests on the acute care floors,” she explains. “When we looked deeper, we recognized that earlier intervention might have changed the trajectory for some of those patients. That realization pushed us to develop a proactive, not reactive, model of support.”

Building a proactive safety net

Critical care outreach models are well supported in the literature, with proven benefits that include better patient outcomes, fewer ICU bounce-backs and higher satisfaction for both patients and families. Craig says CCAD’s leadership recognized that establishing a consistent, expertly trained outreach team could enhance surveillance for high-risk patients and strengthen interdisciplinary communication.

In January 2023, ICU and acute care nursing leaders convened an interprofessional working group led by an ICU nurse manager. Over the following two months, the team developed a comprehensive plan to launch the Critical Care Outreach Nurse Program (CCONP). The project entailed defining program objectives, designing training and education pathways, creating evidence-based protocols and guidelines and establishing communication workflows to ensure seamless collaboration between bedside nurses and physicians.

Craig emphasized that training was a cornerstone of the program’s early development. “We wanted our outreach nurses to be prepared not only clinically, but also in how they support and empower acute care nurses,” she says. “The goal wasn’t to replace the ACU nurses’ clinical judgment — it was to augment it with real-time critical care expertise.”

The team also implemented a structured data collection and monitoring system to measure outcomes, guide program adjustments and support continuous quality improvement. In March 2023, the hospital launched a three-month pilot phase backed by a robust communication campaign to ensure hospital-wide awareness and engagement.

Evidence of impact

At the end of the pilot phase, the data painted a clear picture: the CCONP was achieving its intended goals. The rate of ICU admissions from the hospital’s ACUs dropped significantly, declining from a pre-intervention baseline of 0.46 per 1,000 inpatient days to 0.35 in May–June 2023, and further to 0.23 in July–August and September–October 2023. These improvements were both statistically meaningful and clinically significant, she says, reflecting better detection of deterioration and earlier therapeutic action.

“The numbers confirmed what we were seeing on the units,” Craig notes. “Patients who might previously have gone into crisis were stabilized earlier. We were able to intervene before a rapid decline, and that changes everything for the patient, the family and the care team.”

In addition to fewer unplanned ICU transfers, the hospital recorded a decrease in Code Blue activations and cardiopulmonary arrests outside the ICU. Acute care nurses also reported feeling more supported and more confident when managing complex patients, knowing that a critical care resource was readily available.

In addition, the nursing team sustained momentum by holding monthly forums for critical care outreach nurses, which provided opportunities to share lessons learned and identify new opportunities for program enhancement. The forums quickly became an essential platform for dialogue among bedside nurses, outreach team members, and leadership, Craig says.

Strengthening collaboration and culture

Beyond metrics, Craig says the CCONP has contributed to a cultural shift across CCAD’s inpatient units. Trust between the outreach team and acute care nurses has deepened, and interdisciplinary collaboration has strengthened — a change that Craig sees as one of the program’s most important successes.

“The outreach nurses aren’t just responding to alerts; they’re building relationships,” she says. “They’re rounding with ACU nurses, discussing concerns and helping create care plans that prevent deterioration. It has fostered a sense of partnership that benefits everyone involved.”

Looking ahead

As the hospital continues its pursuit of zero harm, the CCONP stands as a model for how other healthcare organizations can use data, education and collaboration to transform patient care, Craig says.

“Our success highlights the essential role nurses play in early identification, rapid response and system-wide quality improvement,” she explains. “Nurses are the first to notice subtle changes. When we’re equipped with the right tools and supported by the right structures, we can change outcomes. That’s exactly what this program is doing.”