Clinical Case Database / Category: Clinical Care

Recognition, assessment & management of the unwell patient On The Ward

Publication details

Dr Yin Yong Choo, Dr Venkat Shenoy
Foundation Years Journal, volume 9, issue 9, p.38 (123Doc Education, London, October 2015)


Patients go to the hospital because they feel unwell. However, whilst in hospital, a patient who has been stable on the ward may acutely deteriorate and become critically unwell. Early recognition of the severity of the situation, careful assessment of the patient, prompt management using a systematic ABCDE approach, and effective communication between team members are the four main pillars to safely manage the unwell patient on the ward. The ultimate aims are the rapid stabilization of the unwell patient, the prevention of further deterioration, and the appropriate escalation of the patient's care. Most patients who become acutely unwell on the ward show signs of deterioration many hours before their acute decompensation. This may be due to the progression of the primary condition which brought them to a hospital, due to their pre-existing co-morbidities or due to a new problem they have developed since admission. The ability to recognise the early signs of deterioration and manage them accordingly is the key to improvement of the patient's outcome and survival. Physiological signs indicating a patient's deterioration include: reduced oxygen saturations, tachypnoea, hypotension, tachycardia, reduced level of consciousness and increased temperature. These parameters are documented by the nursing and allied healthcare professionals in the patient's observation chart and form a part of the NEWS (national early warning score) system.

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Dr Yin Yong Choo (Corresponding author)

CT2 Anaesthetics
East of England School of Anaesthesia
Basildon Hospital, Nethermayne
Basildon, Essex, SS16 5NL

Dr Venkat Shenoy

Consultant Anaesthetist
Basildon Hospital, Nethermayne
Basildon, Essex, SS16 5NL


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T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

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