BMJ 1999;318:51 ( 2 January )

Letters

Suboptimal ward care of critically ill patients

    Suboptimal care should have been defined
    Assessment of quality of care was flawed
    Active management should prevent cardiopulmonary arrests
    Inadequate staffing means problems are missed
    Doctors don't review patients that nurses identify as highly dependent
    Checklist may help improve referral
    More intensive care beds are needed
    Medical training should focus on basic skills
    Course is available for surgical trainees
    Medical emergency teams improve care
    Authors' reply

Suboptimal care should have been defined

The first 150 words of the full text of this article appear below.

EDITOR---McQuillan et al show that most patients receive suboptimal management of oxygen therapy, airway, breathing, circulation, and monitoring before admission to intensive care.1 In an area of medicine renowned for objective measurement it is surprising that this study should rely on the subjective opinions of two assessors about what constituted suboptimal care. Understandably, their opinions often disagreed.

The authors accept that there are difficulties in relying on assessors' opinions, but we must not underestimate these limitations. The assessors knew the outcomes of the patients, which must have biased their opinions, particularly since suboptimal care is not defined. How suboptimal care was defined is crucial to the paper's message, and more information about the data evaluated by the assessors would have been preferable to the lengthy discussion, much of which was not directly related to the data.

Unfortunately, many of the data are self fulfilling. It is unsurprising that . . . [Full text of this article]
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