The critically ill: following your MEWS.

TLDR: The longer the patient is in hospital before ICU admission, the higher their eventual hospital mortality, and the more patients are referred to intensive care outreach services (ICORS), the more likely they are to die.

Abstract: A 62‐year‐old man with a chest infection is admitted to hospital as an emergency. For the following 5 days, he remains on a ward with a tachycardia of 120–130 bpm and respiratory rates in the mid 30s to low 40s. Despite supplemental oxygen, his recorded saturation often dips below 90%. Five days after admission, he becomes confused and then drowsy. At this time his systolic blood pressure falls below 80 mmHg. His urinary output is not recorded, although his creatinine increases over 6 days from 212 mmol/l at admission to 369 mmol/l. Doctors are concerned and make frequent visits, analyse several arterial blood gas samples and institute intermittent mask continuous positive airway pressure (CPAP) support. Six days after admission a registrar, not involved in the patient's care, notices from the end of the bed that the patient is moribund. The patient is admitted to the intensive care unit (ICU) and is intubated, ventilated and haemofiltered. The patient dies on the ICU 24 days later. This really happened, although some details have been changed to maintain patient confidentiality. Such patients are common on hospital wards across the UK. How do we know this? Because in our hospital, and in another 50 or more, intensive care outreach services (ICORS) have been established over the last year. Compared to patients admitted to ICU from theatres/recovery or the Accident and Emergency (A&E) department, those admitted from hospital wards have a higher percentage mortality (Figure 1).1 Indeed, about 30% of those admitted from a ward to the ICU have survived a cardiorespiratory arrest whilst in the ‘safety’ of a hospital ward. The median time these patients are in hospital before ICU admission is about 6 days. However, the longer the patient is in hospital before ICU admission, the higher their eventual hospital mortality. Some patients are referred to …