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Welcome

Welcome. REACT Course. Why Attend This Course ?. Recognition of sick patient Communication Teamwork. Aims. Identify sick patients Transfer to a safe environment prior to deterioration Management of acute deterioration Reduce clinical errors. Medical Errors.

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Welcome

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  1. Welcome REACT Course

  2. Why Attend This Course ? • Recognition of sick patient • Communication • Teamwork

  3. Aims • Identify sick patients • Transfer to a safe environment prior to deterioration • Management of acute deterioration • Reduce clinical errors

  4. Medical Errors The editor of the BMJ, Dr Richard Smith told BBC Radio 4's Today programme: "Probably 20-30,000 people a year in Britain die of medical errors but then of course many more will be injured and suffer other consequences."

  5. Anyone can make errors - NPSA • Mr Johnson - Chairman, British Medical Association • Professor Sir Catto - President, General Medical Council • Professor Paice - Postgraduate Dean, London Deanery • Dr Simpson - President, Royal College of Anaesthetists • Dr Eccles - Chairman, BMA Junior Doctors Committee • Professor Black - President, Royal College of Physicians • Dr Horton - Editor, The Lancet • Dr Godlee - Editor, British Medical Journal • Professor Sir Underwood - President, Royal College of Pathologists • Mr Ribeiro - President, Royal College of Surgeons • Professor Hayden - Dean of Postgraduate Medical Studies • Dr Neighbour - President, Royal College of General Practitioners • Professor Kumar - Professor of Clinical Medical Education • Professor Jackson - Dean of Postgraduate GP Education

  6. DoH and Modernisation AgencyNational Outreach Forum • 10.8% patients have adverse events: half are preventable • 36% patients receive suboptimal care pre-ICU   • 41% of ICU admissions potentially avoidable    Actually, old news - unfortunately • 10.8% patients have adverse events: half are preventable • 1999-2000 data: Vincent et al BMJ 322(7285) • 36% patients receive suboptimal care pre-ICU • 1996 data: McGloin et al J R Coll Physicians Lond 33(3) • 41% of ICU admissions potentially avoidable • 1992-1993 data: McQuillan et al BMJ 316(7148) Effect of Sub-optimal Care • Quality of care before admission to ICU • McQuillan et al BMJ 316(7148)

  7. Building blocks of care Audit Audit Risk management Risk management Research Mortality Guidelines Research Education Morbidity Systems Guidelines Morbidity Systems Mortality Education Quality Care

  8. Suboptimal care - NCEPOD • 100 consecutive admissions to ICU • 20 patients well managed • 54 received suboptimal management • ICU mortality was worse in those who received suboptimal care (48% compared with 25% in the well managed group). • Admission to the ICU was considered late in 37 patients in the suboptimal group. • Upto 41% of admissions were considered avoidable. • Suboptimal care contributed to morbidity or mortality in most instances. • The main causes of suboptimal care were failure of organisation, lack of knowledge, failure to appreciate clinical urgency, lack of supervision and failure to seek advice.

  9. Improve outcome by • Recognising deterioration • Management of • Airway • Breathing • Circulation • Disability • Assessment • Appropriate interventions

  10. Don’t forget • You are part of a team • So work as a team • If in doubt call for HELP

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