Confidential inquiry into quality of care before admission to intensive care

Abstract

The management of airway, breathing, and circulation, and oxygen therapy and monitoring in severely ill patients before admission to intensive care units may frequently be suboptimal. Major consequences may include increased morbidity and mortality and requirement for intensive care. Possible solutions include improved teaching, establishment of medical emergency teams, and widespread debate on the structure and process of acute care.

Evidenzbasierte Bedarfsplanung f�r Intensivbetten

“…Eine in GB/Südwestengland durchgeführte "vertrauliche" -durch zwei anonyme Gutachter -Untersuchung (McQuillan et al 1998) sagt aus, dass bis zu 40 % der ICU-Aufnahmen aus den "general wards", durch besseres Management von "airway, breathing, circulation, oxygen therapy and monitoring" vermeidbar gewesen wären. Und dass etwa die Hälfte der zugewiesenen Patienten davor suboptimal betreut waren.…”

Understanding Decision Making in Critical Care

“…In these patients, nonrecognition of the problem or its severity, lack of supervision, inexperience, and inappropriate treatment were key factors underlying patient morbidity and mortality. 22,23 …”

A comparison of hospital and critical‐care activity

“…There is a recognised shortfall in nursing numbers [9] and despite occasional adequate funding, recruitment of ICU nursing staff remains a problem. Suboptimal care on the general ward before ICU referral has been highlighted recently [10]; calls for a hospital 'emergency medical team' indirectly recognise the problems of deficiencies in care [11,12]. Such deficiencies in care on the general ward will increase the pressure for ICU management in an attempt to retrieve the clinical situation.…”