Recognising the deteriorating patient and acting quickly is one of the most important skills a doctor working in or around intensive care can develop. Delays in referral to the ICU team are consistently associated with worse patient outcomes — patients who are referred late are more likely to have suffered prolonged periods of physiological compromise, are more difficult to stabilise, and have higher mortality rates. The instinct to ‘wait and see’ or to avoid ‘bothering’ the ICU team is understandable but dangerous.

The ICU team should be thought of as a resource that can be engaged early for advice, support, and review — not just as a final destination for the very sickest patients. A brief phone call to discuss a patient who is mildly deteriorating is far preferable to a crash call two hours later when that same patient has arrested.

This section covers how to recognise when ICU involvement is needed, how to communicate that need effectively, and what to do in the period between referral and ICU review or admission.