ArticleBMJ (Clinical research ed.)1998
Confidential inquiry into quality of care before admission to intensive care.
Article in BMJ (Clinical research ed.), 1998. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 149 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
149 citing papers in PubMed, 3 syntheses or guidelines pooled it, 1,466 citations in OpenAlex.
- Early warning systems and rapid response systems for the prevention of patient deterioration on acute adult hospital wards.The Cochrane database of systematic reviews · 2021Pooled it
- The impact of wearable continuous vital sign monitoring on deterioration detection and clinical outcomes in hospitalised patients: a systematic review and meta-analysis.Critical care (London, England) · 2021Pooled it
- Undergraduate training in the care of the acutely ill patient: a literature review.Intensive care medicine · 2007Pooled it
- Predictors of Respiratory Support Use in Emergency Department Patients With COVID-19-Related Respiratory Failure.Respiratory care · 2022Trial
- Effect of an automated notification system for deteriorating ward patients on clinical outcomes.Critical care (London, England) · 2017Trial
- Early CPAP prevents evolution of acute lung injury in patients with hematologic malignancy.Intensive care medicine · 2010Trial
- Introducing Critical Care Outreach: a ward-randomised trial of phased introduction in a general hospital.Intensive care medicine · 2004Trial
- Indirect ICU Admissions From an Australian Emergency Department: Risk Factors and Outcomes.Emergency medicine Australasia : EMA · 2026Observational
- Assessing Risk of Early ICU Admission or Death at Emergency Department Triage: Clinical Judgment Versus Early Warning Scores.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2026Observational
- Article
- Early Warning Scores in Emergency Department Patients Aged 80 Years or Older.JAMA network open · 2026Article
- Factors Associated with Survival in Non-Trauma Subjects Treated in the "Shock Room" in a Tertiary Medical Center.Open access emergency medicine : OAEM · 2026Article
- Rinaldo's role in the medical emergency team and rapid response systems.Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine · 2025Article
- Performance of Continuous Digital Monitoring of Vital Signs with a Wearable Sensor in Acute Hospital Settings.Sensors (Basel, Switzerland) · 2025Article
- Effectiveness of ultra-rapid (20 min) high-frequency in-situ cardiac arrest simulations in a high-volume operating department - A tool for evaluating and implementing emergency routines.Resuscitation plus · 2025Article
- Successfully initiating an escalation of care in acute ward settings-A qualitative observational study.Journal of advanced nursing · 2025Observational
- The Scoring Model to Predict ICU Stay and Mortality After Emergency Admissions in Atrial Fibrillation: A Retrospective Study of 30 366 Patients.Clinical cardiology · 2025Article
- Prognostic value of heart rate variability for risk of serious adverse events in continuously monitored hospital patients.Journal of clinical monitoring and computing · 2024Article
- Development and implementation of an artificial intelligence-enhanced care model to improve patient safety in hospital wards in Spain.Acute and critical care · 2024Article
- Discrepancies between Promised and Actual AI Capabilities in the Continuous Vital Sign Monitoring of In-Hospital Patients: A Review of the Current Evidence.Sensors (Basel, Switzerland) · 2024Review
89 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
- Commented on by
- Commented on by
- Commented on by
- Commented on by
- Commented on by
- Commented on by
- Commented on by
- Commented on by
- Commented on by
- Commented on by
- Erratum issued
Authors and funding
10 authors at 5 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo examine the prevalence, nature, causes, and consequences of suboptimal care before admission to intensive care units, and to suggest possible solutions.
designProspective confidential inquiry on the basis of structured interviews and questionnaires.
settingA large district general hospital and a teaching hospital. SUBJECTS: A cohort of 100 consecutive adult emergency admissions, 50 in each centre.
main outcome measuresOpinions of two external assessors on quality of care especially recognition, investigation, monitoring, and management of abnormalities of airway, breathing, and circulation, and oxygen therapy and monitoring.
resultsAssessors agreed that 20 patients were well managed (group 1) and 54 patients received suboptimal care (group 2). Assessors disagreed on quality of management of 26 patients (group 3). The casemix and severity of illness, defined by the acute physiology and chronic health evaluation (APACHE II) score, were similar between centres and the three groups. In groups 1, 2, and 3 intensive care mortalities were 5 (25%), 26 (48%), and 6 (23%) respectively (P=0.04) (group 1 versus group 2, P=0.07). Hospital mortalities were 7 (35%), 30 (56%), and 8 (31%) (P=0.07) and standardised hospital mortality ratios (95% confidence intervals) were 1.23 (0.49 to 2.54), 1.4 (0.94 to 2.0), and 1.26 (0.54 to 2.48) respectively. Admission to intensive care was considered late in 37 (69%) patients in group 2. Overall, a minimum of 4.5% and a maximum of 41% of admissions were considered potentially avoidable. Suboptimal care contributed to morbidity or mortality in most instances. The main causes of suboptimal care were failure of organisation, lack of knowledge, failure to appreciate clinical urgency, lack of supervision, and failure to seek advice.
conclusionsThe management of airway, breathing, and circulation, and oxygen therapy and monitoring in severely ill patients before admission to intensive care units may frequently be suboptimal. Major consequences may include increased morbidity and mortality and requirement for intensive care. Possible solutions include improved teaching, establishment of medical emergency teams, and widespread debate on the structure and process of acute care.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.