Half of patients in intensive care receive suboptimal care
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《英国医生杂志》
Consultants need to be more available to supervise emergency medical admissions to improve the care of acutely sick patients, recommends a report.
A study by the charity the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) shows that a quarter of patients who were admitted to intensive care units in England and Wales in one month in 2003 died. Nearly half of these patients received care that was judged to be less than good practice. And deficiencies in care in a third of the admitted patients may have contributed to their death, it says.
The charity aims to maintain and improve medical and surgical care. Its report covered all 1677 patients who were admitted to intensive care units in hospitals in England and Wales in June 2003. Of these patients 560 died, and 439 of the deaths were investigated fully by the charity.
In general, senior house officers were left in charge of caring for severely ill patients, especially in the evening and at night—the busiest time for new admissions to intensive care units, the study shows. In nearly 6 in 10 cases consultants had no knowledge or input into the referral, and one in four patients had to wait for more than 12 hours before being seen by a consultant.
"Patients should rarely be admitted to ICU without the prior knowledge or involvement of a consultant intensivist," the report says.
Creating new acute physician posts may help in the long term to improve the care of patients who need intensive care, says the report. But in the short term consultants' job plans should reflect the pattern of demand for emergency admissions, especially at the busiest times in the evenings and at night, it recommends. "Provision should be made for planned consultant presence in the evenings (and perhaps at night in busier units)," it says.
The report also calls for better training for junior doctors in how to recognise critical illness and the role of fluid and oxygen treatment in managing emergency patients. It adds that consultants should supervise junior doctors more closely.(Zosia Kmietowicz)
A study by the charity the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) shows that a quarter of patients who were admitted to intensive care units in England and Wales in one month in 2003 died. Nearly half of these patients received care that was judged to be less than good practice. And deficiencies in care in a third of the admitted patients may have contributed to their death, it says.
The charity aims to maintain and improve medical and surgical care. Its report covered all 1677 patients who were admitted to intensive care units in hospitals in England and Wales in June 2003. Of these patients 560 died, and 439 of the deaths were investigated fully by the charity.
In general, senior house officers were left in charge of caring for severely ill patients, especially in the evening and at night—the busiest time for new admissions to intensive care units, the study shows. In nearly 6 in 10 cases consultants had no knowledge or input into the referral, and one in four patients had to wait for more than 12 hours before being seen by a consultant.
"Patients should rarely be admitted to ICU without the prior knowledge or involvement of a consultant intensivist," the report says.
Creating new acute physician posts may help in the long term to improve the care of patients who need intensive care, says the report. But in the short term consultants' job plans should reflect the pattern of demand for emergency admissions, especially at the busiest times in the evenings and at night, it recommends. "Provision should be made for planned consultant presence in the evenings (and perhaps at night in busier units)," it says.
The report also calls for better training for junior doctors in how to recognise critical illness and the role of fluid and oxygen treatment in managing emergency patients. It adds that consultants should supervise junior doctors more closely.(Zosia Kmietowicz)