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British Journal of Anaesthesia, 2004, Vol. 92, No. 6 784-786
© 2004 The Board of Management and Trustees of the British Journal of Anaesthesia

Editorial II

Not waving, but drowning

D. W. McKeown

University of Edinburgh, Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK E-mail: dermot.mckeown@ad.ac.uk

The first 10% of the full text of this article appears below.

Modern hospitals can be dangerous. Reduced numbers of staff, inexperienced staff, and staff working for limited hours can allow a patient to become unwell without being noticed or treated properly. Reductions in the number of hospital beds mean that the patients in these beds are sicker and have more things wrong with them.1 If patients deteriorate without changes being noticed and treated, then serious consequences develop, such as cardiac arrest.2 The most pressing interventions required to prevent severe deterioration may be relatively simple3 and early response to certain conditions can reduce mortality and morbidity,4 but most hospitals do not have a system to ensure an adequate response to acute illness.

To identify deteriorating patients and start treatment promptly, solutions have been proposed, introduced, developed and promoted. An ideal system would rapidly:

identify patients at . . . [Full Text of this Article]


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