The ACUTE initiative

Each year, an estimated 23 000 preventable in-hospital cardiac arrests occur in the UK.1 It is well recognised that, in many of these cases, signs of clinical deterioration remain undetected or ignored by ward staff in the minutes to hours preceding a cardiac arrest.2 A recent report by the National Confidential Enquiry into Patient Outcome and Death, An Acute Problem, evaluated the care of more than 1500 medical admissions to intensive care and found evidence of suboptimal management in nearly 50% of cases.3 Suboptimal care is often related to poor management of simple aspects of acute care—those involving the patient's airway, breathing, and circulation; oxygen administration; and fluid balance.45 Other contributory factors include organisational failures, a lack of knowledge, failure to appreciate the clinical urgency of a situation, a lack of supervision, failure to seek advice, and poor communication.67 Effective earlier intervention requires staff trained in the care of acutely ill patients. Ideally, competence (knowledge, skills, and attitudes) in caring for these patients should be a clearly defined component of healthcare curriculums, starting at undergraduate level.

The General Medical Council, the licensing body for doctors in the UK, requires medical undergraduates at completion of training to be able to undertake cardiopulmonary resuscitation and advanced life support (ALS); understand the principles of recognising and managing acute illness; and administer oxygen safely.8 However, the GMC does not identify the specific competencies nor a common core curriculum that should be acquired in these aspects of acute care. A survey of UK medical schools in 2001 found that all taught basic life support (using variable methods) and 79% taught some aspects of ALS. However, …