To examine the prevalence, nature, causes, and consequences of suboptimal care before admission to intensive care units, and to suggest possible solutions.
Prospective confidential inquiry on the basis of structured interviews and questionnaires.
A large district general hospital and a teaching hospital.
A cohort of 100 consecutive adult emergency admissions, 50 in each centre.
Opinions 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.
Assessors 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 I 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. (...)
Mots-clés Pascal : Soin intégré, Enquête opinion, Confidentialité, Facteur qualité, Etude cohorte, Prévalence, Soin intensif, Etiologie, Prospective, Evaluation, Homme, Angleterre, Grande Bretagne, Royaume Uni, Europe, Organisation santé
Mots-clés Pascal anglais : Managed care, Opinion inquiry, Confidentiality, Q factor, Cohort study, Prevalence, Intensive care, Etiology, Prospective, Evaluation, Human, England, Great Britain, United Kingdom, Europe, Public health organization
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0301130
Code Inist : 002B30A04D. Création : 27/11/1998.