A Hospital-Wide System for Managing the Seriously Ill: A Model of Applied Health Systems Research

We have had many similar patients admitted from the general wards who had slowly deteriorated without adequate management. Interestingly the attending nursing staff usually charted the deterioration perfectly and often the nursing staff shared their concerns with junior medical staff. However, the system did not seem to respond rapidly enough to the seriously ill on general wards, nor was there sufficient expertise, skills or supervision when medical assistance eventually arrived. This is a saga extending over almost 20 years, of how the principles of health systems research were used to address this issue. It is a saga of the specialty of intensive care moving out of its four walls and realizing that outcome is determined as much by the level of care delivered before and after the ICU as it is by the interventions within the ICU.

“For it happens in this, as the physicians say it happens in hectic fever, that in the beginning of the malady it is easy to cure but difficult to detect, but in the course of time, not having been either detected or treated in the beginning, it becomes easy to detect but difficult to cure.” (Niccolo Machiavelli, The Prince)