1. Managing the deteriorating patient
Rob Thompson
Consultant Intensive Care / Anaesthetist

2. 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.

3. 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)

6. 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