Nurse-Led Critical Care Outreach Service Strengthens Patient Care at Letterkenny University Hospital

Letterkenny University Hospital’s Critical Care Outreach (CCO) service is playing 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.

Established in March 2023 and led by two Advanced Nurse Practitioners (ANPs), the service supports patients in the hospital who are identified as being at high risk of clinical deterioration, including changes in respiratory rate, heart rate, blood pressure or level of consciousness.

Concerns of clinical deterioration can be escalated directly by the clinical team caring for the patient to the ANP Critical Care Outreach service that prompts a timely review and targeted interventions, which include:  

• Undertaking advanced clinical assessment to prioritise care needs and act as a link between specialist services
• Initiating urgent treatment where appropriate, such as oxygen therapy, intravenous fluids, antibiotics, and nurse prescribing
• Providing real-time guidance and support to ward staff to help stabilise the patient
• Ongoing monitoring of the patient’s condition to ensure improvement or timely escalation of care
• Offering advocacy and support for patients and their families throughout the episode of care

The service promotes the early recognition of deterioration, timely escalation of treatment, and improved patient outcomes, in line with the Health Service Executive Model of Care. This approach supports the delivery of the right care, in the right place, at the right time.

A central element of the service is its ANP-led 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.

Since its introduction, the service is now well established and fully embedded within a phased expansion across the hospital. 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 alone, 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 from the Irish National ICU Audit.

The service is led by two highly experienced Advanced Nurse Practitioners whose clinical backgrounds span critical care, emergency medicine, and international healthcare systems.

Advanced Nurse Practitioners Leading the Service

Originally from Connemara in County Galway, Gráinne Nee qualified with a Bachelor of Science in Nursing from Atlantic Technological University (ATU) Castlebar in 2012. She has built a broad clinical foundation across acute and intensive care environments in Ireland and the UK.

Her early career included roles in acute medical assessment at Wexham Park Hospital in Slough, followed by experience in paediatric care at Evelina London Children’s Hospital. She later worked in intensive care settings at both University College Hospital London and Westmoreland Street Hospital, developing a strong specialist critical care skillset.

Returning to Ireland in 2017, Gráinne joined the Intensive Care Unit at Letterkenny University Hospital. While working in ICU, she completed a Graduate Diploma in Critical Care nursing through University College Dublin and went on to achieve a Master of Science in Intensive Care Nursing at the University of Galway.

In 2023, she took up the post of candidate Advanced Nurse Practitioner in Critical Care Outreach. After completing a two-year candidacy, and a Postgraduate Diploma in Advanced Practice (Nursing) at the University of Galway, Gráinne registered as an Advanced Nurse Practitioner.

Reflecting on the role, Gráinne said: “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.”

Lisa McHugh, originally from Carnacon in County Mayo, qualified with a Bachelor of Science in Nursing from Atlantic Technological University (ATU) Letterkenny in 2009.

She began her nursing career at Letterkenny University Hospital in the Stroke Rehabilitation Unit before relocating to the United Kingdom, where she gained extensive experience in emergency and critical care. Her UK career included posts in the Emergency Department at East Surrey Hospital and the Intensive Care Unit at King’s College Hospital NHS Foundation Trust. During this period, Lisa also became part of a developing Critical Care Outreach team, gaining early experience in the specialty.

After more than a decade working in London, Lisa returned to Letterkenny University Hospital in 2023 to take up the role of candidate Advanced Nurse Practitioner in Critical Care Outreach. Following a two-year candidacy, and a Master of Science in Advanced Practice (Nursing) at the University of Galway, Lisa registered as an Advanced Nurse Practitioner.

“Our 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,” explains Lisa.

Director of Nursing at Letterkenny University Hospital, Una Cardin, said: “The Critical Care Outreach programme is a significant development in how we support patients at risk of deterioration.

“It has strengthened clinical decision-making at ward level, improved patient outcomes, and enhanced collaboration across multidisciplinary teams. The expertise and leadership of the ANP team has been central to its success and ongoing development.”

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 Letterkenny University Hospital 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.