A new toolkit from the Royal College of Physicians (RCP) for the recognition and care of seriously ill patients recommends that patients admitted as emergencies should only transfer out of the acute medical unit to a ward area that has facilities to meet their clinical needs.
There is increasing pressure to move patients rapidly to beds on wards throughout the hospital. The toolkit recommends the use of the National Early Warning Score (NEWS), a ‘track and trigger’ scoring system for physiological measurements, to quickly identify patients who are severely ill or at risk of sudden deterioration. The RCP is concerned about patients who are identified as requiring an intensity of monitoring and care greater than that available on a standard medical ward. More enhanced care beds, with higher nurse to patient ratios, should be available on acute medical units. In addition, hospitals should designate enhanced care beds on selected medical wards that manage acutely ill patients. ‘The medical patient at risk: recognition and care of the seriously ill or deteriorating medical patient’, is the sixth in the series of RCP Acute Care Toolkits. It puts NEWS at the heart of the initial assessment of patients admitted as an emergency. Repeated NEWS values ‘track’ the patient’s progress and, in the event of a deterioration, ‘trigger’ an escalation in medical and nursing care. The score also guides the intensity of care required and the clinical area and staffing level best able to provide this care at any time point during the hospital stay. Commenting on the new toolkit, Dr Rhid Dowdle, lead author said: “One of the major drivers for this toolkit was the identification of shortcomings in the care of seriously unwell medical patients by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD). I hope the recommendations we have made will, if implemented, improve the care of this vulnerable group of patients.”
