Rethinking the problem of clinically deteriorating patients: Time for theory-informed solutions.

It is over 20 years since McQuillan et al. [1] McQuillan P. Pilkington S. Allan A. Taylor B. Short A. Morgan G. et al. Confidential inquiry into quality of care before admission to intensive care. BMJ. 1998; 316: 1853-1858 Crossref PubMed Google Scholar reported deficiencies in clinical care that in-patients in hospital wards received before being transferred to an intensive care unit (ICU). In more than half of cases, there was poor recognition of changes to vital signs and delays in contacting a more senior clinician resulting in increased patient mortality, morbidity, and resource consumption in the ICU. [1] McQuillan P. Pilkington S. Allan A. Taylor B. Short A. Morgan G. et al. Confidential inquiry into quality of care before admission to intensive care. BMJ. 1998; 316: 1853-1858 Crossref PubMed Google Scholar These results have been echoed in multiple studies across the world since that time. Common across this work is the vulnerability of hospitalised patients who clinically deteriorate without appropriate recognition and intervention and the urgent need for a system-wide approach to strengthen care in this area and ensure patient safety. Rapid response systems (RRSs) have since been theorised as including afferent (recognition) and efferent (response) limbs [2] DeVita M.A. Bellomo R. Hillman K. Kellum J. Rotondi A. Teres D. et al. Findings of the first consensus conference on medical emergency teams∗. Crit Care Med. 2006; 34: 2463-2478 Crossref PubMed Scopus (607) Google Scholar and operationalised in various forms in acute hospitals internationally.