1) More attention should be paid to patients exhibiting physiological abnormalities. This is a marker of increased mortality risk (
p. 226)
2) The importance of respiratory rate monitoring should be highlighted. This parameter should be recorded at any point that other observations are being made ( p. 226)
3) Use of early warning scores can help to monitor patients and trigger appropriate escalation of care. Use them with care as they can still miss some acutely unwell patients ( pp. 226–227)
4) It is inappropriate for referral and acceptance to ICU to happen at junior doctor (<ST3) level ( pp. 228–229)
5) Training must be provided for junior doctors in the recognition of critical illness and the immediate management of fluid and oxygen therapy in these patients ( p. 230)
6) Consultants must supervise junior doctors more closely and should actively support juniors in the management of patients rather than only reacting to requests for help
7) Junior doctors must seek advice more readily. This may be from specialized teams such as outreach services or from the supervising consultant
8) Each hospital should have a track and trigger system that allows rapid detection of the signs of early clinical deterioration and an early and appropriate response ( pp. 226–227)
9) All entries in the notes should be dated and timed and should end with a legible name, status, and contact number (bleep or telephone) ( p. 76)
10) Each entry in the notes should clearly identify the name and grade of the most senior doctor involved in the patient episode ( p. 76).
