6. Referral process

The review

As discussed earlier, one possible measure to improve care of acutely unwell patients is the involvement of an outreach service. In this study 56% (116/208) of hospitals had an outreach service. However, only 23% of patients referred to critical care were reviewed by an outreach service (Table 3). The reasons for this apparent discrepancy are not clear but it may reflect the fact that outreach services have developed in an unstructured manner with no clear strategy. Indeed, few outreach services are available 24 hours per day, 7 days per week and often focus on patients from defined specialties, mainly surgical. It is therefore premature to rely on outreach services to meet the needs of acutely unwell inpatients, although the Royal College of Physicians and its members have suggested this
approach ^7,30.

Table 4 shows that 82% of patients were reviewed by the intensive care service prior to admission. This is a surprisingly low figure and whilst there may be good reasons to expedite ICU admission for severely ill patients, this should rarely be at the expense of a direct patient review. Table 5 shows that this review rate was not influenced by time of day.

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