Suboptimal care of patients before admission to intensive care

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Abstract
Papers(p 1853 During the past decade deficiencies in the quality of medical care have precipitated detailed scrutiny in the form of national confidential inquiries. These inquiries have examined perioperative deaths (NCEPOD), maternal deaths, and more recently, babies' deaths.1 2–3The 1993 NCEPOD report showed that two thirds of perioperative deaths occurred three or more days after surgery, usually from cardiorespiratory complications and in a ward environment. The riskiness of ward care is illustrated again this week in a different sort of confidential inquiry. On p 0000 McQuillan and colleagues present the results of a confidential inquiry into the quality of care received by 100 patients admitted to intensive care (p 0000).4 After conducting structured interviews with the referring and intensive care clinical teams, the investigators completed a questionnaire that focused on the recognition, investigation, monitoring, and management of each patient's airway, breathing, and circulation (ABCs). Two independent assessors (a nephrologist and an anaesthetist) evaluated the resulting questionnaires. Both agreed that 54 of the 100 patients received suboptimal care. Mortality in the intensive care unit for these patients was 48%, almost twice that of the 20 patients who they agreed had been managed well. In addition, two thirds of these …