Intended for healthcare professionals

Practice NICE guidelines

Recognising and responding to acute illness in adults in hospital: summary of NICE guidance

BMJ 2007; 335 doi: (Published 02 August 2007) Cite this as: BMJ 2007;335:258
  1. Mary Armitage, consultant physician1,
  2. Jane Eddleston, consultant in intensive care medicine2,
  3. Tim Stokes, associate director, centre for clinical practice3
  4. Guideline Development Group
  1. 1Bournemouth Diabetes and Endocrine Centre, Royal Bournemouth Hospital, Bournemouth, Dorset BH18 8BT
  2. 2Manchester Royal Infirmary, Manchester M13 9WL
  3. 3National Institute for Health and Clinical Excellence, Manchester M1 5AN
  1. Correspondence to: M Armitage
  • Accepted 26 June 2007

Why read this summary?

Patients in hospital are at risk of becoming acutely ill due to their underlying diagnosis, associated comorbidities, and increasing age and the increasing complexity of care delivered in our hospitals. The recognition of deteriorating health by clinical staff is often delayed or managed inappropriately, resulting in late referral to critical care, avoidable intensive care admissions, and many unnecessary patient deaths.1 This article summarises the most recent guidance from the National Institute for Health and Clinical Excellence (NICE) on improving the recognition and response to acute illness in adults in hospital.2


NICE recommendations are based on systematic reviews of best available evidence. When minimal evidence is available, a range of consensus techniques is used to develop recommendations. In this summary, recommendations derived primarily from consensus techniques are indicated with an asterisk (*).

Initial assessment

Adult patients in acute hospital settings, including patients in the emergency department for whom a clinical decision to admit has been made, should have:

  • Physiological observations recorded at the time of their admission or initial assessment.*

  • A clear, written monitoring plan that specifies which physiological observations should be recorded and how often.* The plan should take account of the:

    • - Patient's diagnosis

    • - Presence of comorbidities

    • - Agreed treatment plan.

Staff undertaking these procedures should be trained to record these observations, understand their clinical relevance, and act upon them.*

As a minimum, the following physiological observations should be recorded at the initial assessment and as part of routine monitoring:*

  • Heart rate

  • Respiratory rate

  • Systolic blood pressure

  • Level of consciousness

  • Oxygen saturation

  • Temperature.

Routine monitoring

  • Use physiological “track and trigger” systems to monitor all adult patients in acute hospital settings. (Such systems comprise the periodic observation of selected basic physiological signs (tracking) with predetermined calling or response criteria (trigger) for requesting the attendance of staff who have specific competencies in …

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