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Recognising and responding to acute illness in patients in hospital

BMJ 2007; 335 doi: (Published 06 December 2007) Cite this as: BMJ 2007;335:1165
  1. Kathryn M Rowan, director1,
  2. David A Harrison, statistician1
  1. 1Intensive Care National Audit and Research Centre (ICNARC), London WC1H 9HR
  1. kathy.rowan{at}

Leadership, culture change, education, support, and regular auditing are key

The recognition of and response to potentially life threatening acute illness on hospital wards is of increasing concern. Changes in the type and availability of staff combined with the need to manage patients with increasingly complex problems have highlighted this concern.

Patients who develop severe organ failure often have abnormal physiological signs, sometimes for hours before their final “collapse.” Attempts to improve how we identify and manage these patients disregarded the lack of robust evidence,1 and national policies and initiatives promoting new models of care were issued in England (critical care outreach services),2 3 the United States (rapid response teams),4 and Australia (medical emergency teams).5

In their paper in this week’s BMJ, Buist and colleagues report their experience of a model that incorporates a method to improve the recognition of acute illness (medical emergency team calling criteria) with skilled personnel (the medical emergency team) to ensure a timely and appropriate response. The model is underpinned by an ongoing programme of education and support, both formal (an orientation programme for interns and a professional development course for medical registrars) …

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