Intended for healthcare professionals


Quality of care before admission to intensive care

BMJ 1999; 318 doi: (Published 16 January 1999) Cite this as: BMJ 1999;318:195

Deaths on the wards might be prevented

  1. D R Goldhill, Senior lecturer (,
  2. L M Worthington, Specialist registrar,
  3. A J Mulcahy, Specialist registrar,
  4. M M Tarling, Research nurse
  1. Anaesthetics Unit, Royal London Hospital, London E1 1BB
  2. The New Children's Hospital, Parramatta, NSW 2124, Australia

    EDITOR—The greatest number of deaths in the intensive care unit, and the highest percentage mortality, is in patients admitted to intensive care from hospital wards.1 McQuillan et al focus on the inadequate care patients received before admission to the intensive care unit.2 Similar concerns led us to examine deaths on our hospital wards. We hypothesised that some patients with illnesses that they may recover from do not receive optimal treatment and have a cardiac arrest and die on the wards or deteriorate to the point where intensive care admission and resuscitation is deemed futile and a “do not resuscitate” order is written.

    There were 316deaths on our hospital wards between 1June and 30November 1997.A do not resuscitate order was not made for 55patients (17%). Their average age was 66.1(SD 14.7,range 21-90) years and they were in hospital a median of 8(interquartile range 3-14) days before death. Although 17(31%) patients received cardiopulmonary resuscitation before death, resuscitation would …

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