An investigation into the quality of care received by 100 critically ill patients admitted to intensive care units in two hospitals in Southampton and Portsmouth found that in 54 the standard was "sub-optimal", and 26 of these patients died.
This was almost twice the death rate among the 20 patients whose care was judged to have been managed well. The patients had suffered heart attacks, road accidents and many were admitted from general wards to the intensive care unit with a range of conditions.
Dr Peter McQuillan, consultant in intensive care and anaesthesia at Queen Alexandra Hospital, Portsmouth, who co-ordinated the study, says in the British Medical Journal that emergency admissions have risen by 50 per cent since 1984 and that this rise in numbers should not be at the expense of quality of care. He says a "major re-evaluation" of the way acute care is provided is required.
The authors found there were delays affecting two thirds of the 54 patients who were not treated adequately, which meant they were admitted late into intensive care. Breathing and circulation problems were poorly managed before admission and the patients' condition was inadequately monitored.
Most of the cases were dealt with by junior doctors who failed to appreciate their clinical urgency, lacked supervison and failed to seek advice. These problems were compounded by poor organisation and a lack of knowledge.
The findings "suggest a fundamental problem of failure to appreciate that airway, breathing and circulation are the pre-requisites of life and that their dysfunctions are the common denominators of death ... The concept of doctors as `physiology police' may have been lost."
They authors suggest that one way of dealing with the shortcomings may be to create medical emergency "hit squads" which would respond immediately to patients with breathing or circulation problems. It was estimated that 41 per cent of the patients might have avoided admission to intensive care had earlier care been properly provided.
The study was carried out in 1992-93 and the authors say they believe the standard of care has improved since.