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Royal College of Physicians

Clinical Articles, Lead Article

Time to Intervene: RCP comment on NCEPOD report

Dr Mark Temple, the Royal College of Physicians’ (RCP) acute medicine fellow, has welcomed the publication of the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report ‘Time to Intervene’,1 which highlights the importance of early consultant review of patients admitted acutely to hospital.

The RCP believes that consultant physicians should be at the forefront of delivering high quality care to acutely unwell patients seven days a week.2 The quality of patient care in the first 48 hours in hospital is a critical determinant of clinical outcomes. Consultants should be involved in decisions to escalate treatment or transfer care to the intensive care unit for those patients who fail to respond to initial treatment or deteriorate.

In July the RCP will launch a National Early Warning Score (NEWS), which will alert doctors and nurses when a patient is deteriorating and trigger a consistent approach to the escalation of their care, including the involvement of senior doctors.3

Decisions about the appropriateness of cardiopulmonary resuscitation in the event of cardiac arrest are complex and consultants should be involved in these decisions early in a patient’s acute illness. There is also a need for the healthcare professions and the public to develop a shared understanding of the limitations of CPR and the very low success rate of this intervention in patients where cardiac arrest occurs secondary to non-cardiac disease.4

References

1. Read full NCEPOD report at: http://www.ncepod.org.uk/2012report1/downloads/CAP_fullreport.pdf

2. RCP statement from December 2010 on the need for consultant physicians to be available on-site for at least 12 hours a day, 7 days a week:
http://www.rcplondon.ac.uk/press-releases/patients-deserve-better-out-hours-care-says-rcp-president-0

3. The National Early Warning Score will be launched at a press conference on Thursday 26 July 2012

4. In the NCEPOD Time to Intervene study, of the 200 patients who survived the immediate CPR attempt, only 85 survived to hospital discharge (14.5% survival to hospital discharge rate: 85/585).  The survival rate to discharge was much lower – 8% (22/262 cases) – in cardiac arrests secondary to noncardiac disease.

Published on: June 25, 2012

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