Suboptimal ward care of critically ill patients

More information about the training of assessors should be sought, better evidence of interrater reliability should be presented, and implicit reviews of the process of care should be blinded to the subsequent process and outcome to avoid bias. Because implicit and explicit review methods each have...

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Bibliographic Details
Published in:BMJ 1999-01, Vol.318 (7175), p.51-55
Main Authors: Gorard, David, Walshe, Kieran, Wood, Jeremy, Smith, Andrew, Youngs, Paul J., Ringrose, Tim, Garrard, Christopher, McAllister, C., McGovern, S. J., Duncan, Peter W., Nightingale, Peter, Macartney, Ian, Ryan, Johanna, Shelly, Maire P., Pritchard, Carl, Anderson, Iain D., Rowlands, Brian J., Mercer, Michael, Fletcher, Stephen J., Bishop, Gillian F., McQuillan, Peter, Pilkington, Sally, Allan, Alison, Taylor, Bruce, Smith, Gary, Nielson, Mick, Short, Alasdair, Morgan, Giles, Collins, Charles
Format: Article
Language:English
Subjects:
Cardiac arrest
Critical care
Health care quality
Hospital admissions
Hospital beds
Hospital units
Hospitals
Intensive care
Intensive care units
Letters
Medical referrals
Medical specialists
Mortality
Oxygen therapy
Physicians
Physiology
Teaching
Workloads
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Summary:More information about the training of assessors should be sought, better evidence of interrater reliability should be presented, and implicit reviews of the process of care should be blinded to the subsequent process and outcome to avoid bias. Because implicit and explicit review methods each have advantages and disadvantages, it may be advisable to use both and compare their results rather than to opt for one or the other. Intensive care may be appropriate but is more likely to benefit patients if they are referred early.\n Amalgamation of data on 33612 patients from three large UK databases 2 (Intensive Care National Audit and Research Centre, Critical Care Audit, personal communication) shows that cardiopulmonary resuscitation occurs within 24hours of admission to intensive care in 3.5% of patients referred from theatre or recovery (mortality 49.5%), 14.3% of accident and emergency referrals (mortality 65.1%), and 15.9% of ward referrals (mortality 73.3%). [...]ward patients may be exposed to a high risk of avoidable cardiorespiratory arrest which carries a particularly grave prognosis.
ISSN:0959-8138
1468-5833
1756-1833
DOI:10.1136/bmj.318.7175.51