Outreach

During the past few years evidence has begun to emerge suggesting that some hospital patients exhibit premonitory signs of cardiac arrest, which may be observed by nursing and medical staff but are frequently not acted upon (Franklin and Mathew, 1994; Rich, 1999). Similar findings have been observed in relation to deterioration in the patients’ condition prior to admission to ICU (Goldhill, 1997; McQuillan et al., 1998; Goldhill et al., 1999a; McGloin et al., 1999). These studies suggest that early recognition and treatment of these signs may prevent the necessity for some ICU admissions, thus reducing morbidity and mortality, and making better uses of costly intensive care resources. As patients admitted from hospital wards have a higher overall percentage mortality than patients admitted from other areas of the hospital (Goldhill and Sumner, 1998), an improvement in the management of seriously ill patients prior to ICU admission could potentially improve outcome.