A quality review of high-dependency patient care.

In order to develop strategies to improve high-dependency (HD) patient care, a continuous quality improvement (CQI) study was initiated in August 1994. It sought to establish a system for the collection and evaluation of relevant information concerning medical and nursing management of HD patients. This CQI study followed a high-dependency areas needs analysis undertaken in January, 1994. Conducted over a 12-week period (August-October, 1994) the CQI study involved 92 HD patients who required cardiac and/or respiratory monitoring. The study revealed a low HD bed occupancy rate, inadequate documentation by medical staff of the need for monitoring, and insufficient numbers of nursing personnel specifically educated to care for HD patients. Recommendations include increased consultants surveillance, immediate assessment of HD patients by a medical officer on the ward, a documented plan for monitoring, avoidance of after-hours discharge from operating theatres or intensive care, and the implementation of an education program for HD area nurses.