- The quality of the initial hospital admission history and examination was acceptable in 90% of cases. It is worrying that one in 10 patients have an incomplete history and examination.
- Despite an acceptable history and examination, initial treatment was often delayed, inappropriate or both.
- Although the data are difficult to collect from casenotes it seems likely that, despite RCP recommendations, consultant physician involvement in the first 24 hours remains low. Data were available to assess the timing of patient review by a consultant physician in just 40 of the 439 deaths for which casenotes were available. Amongst these 40 cases, a consultant physician did not review 17 patients within 24 hours of admission to hospital.
- Patients often had prolonged periods of physiological instability prior to admission to ICU. In patients who had been in hospital more than 24 hours prior to ICU admission, 66% exhibited physiological instability for more than 12 hours.