Managing the deteriorating patient Rob Thompson Consultant Intensive Care / Anaesthetist

Analysis of consecutive patients admitted to critical care MacQuillan et al (1998) At least 54% received suboptimal care At least 39% admitted critical care late in course of illness Hospital mortality 56% (suboptimal care) vs 35% (good care) Failure of organisation, lack of knowledge, failure to appreciate urgency, experience, supervision at fault NCEPOD ‘An acute problem’ (2005) 66% showed physiological derangement > 12 hours Little consultant involvement prior to critical care No consultant knowledge of referral in 57% Care ‘less than good’ in 57% of patients that died Ability to seek advice, appreciation of urgency and supervision criticised.

How it works!! Recognition of sick patients: Clinical assessment & EWS Graded response system: Increase in observations frequency, review by medical team & SOS Management plan (& contingency plan)

Plan, plan, plan. Investigations Interventions Frequency of observations Parameters for review Senior review / advice. Other specialist referral? Contingency plan if continues to deteriorate Critical care Ceiling of care End of life care ?DNACPR