ABSTRACT
The discontent regarding Intensive Care Unit (ICU) provision occurred during the 1990s, highlighting the failings of critical care services. Recently, healthcare professionals have seen many great changes in the way critical care is delivered. Today, there is a more consistent approach in the organisation of critical care services, achieved through the strategic document Comprehensive Critical Care (DOH, 2000a). This strategy led to a revision of critical care services and produced a complete process of care for the critically ill and focused on the level of care needed by individual patients and their families at any point during their illness. There is now a pro-active approach using a ‘whole systems’ approach which attends to the needs of those at risk of critical illness as well as those who are critically ill. Comprehensive Critical Care strategy is emerging as a uniform standard throughout the NHS, regardless of location or speciality, i.e. ‘no walls’ philosophy. It is now viewed as a new speciality based on the severity of illness that is focusing on the needs of the patient, central to the service provided. While there has been significant improvement in caring for acutely/critically ill patients there are many improvements still to be done. There is still the possibility that patients who are, or become, acutely unwell may receive suboptimal care (NICE, 2007a). This is possibly due to unrecognised deterioration, lack of knowledge to interpret indications of clinical deterioration, lack of rapid intervention or indeed gross underfunding to provide adequate resources, including staff. In response the National Institute for Health and Clinical Excellence (NICE) has produced guidance and recommendations on a number of areas affecting the acutely ill adult in hospital. These include: physiological observations, physiological track and trigger, recognition of deterioration and transfer.
