(SPOT)light: Sepsis Pathophysiological and Organisational Timing


The purpose of this study was to help estimate the effect of prompt admission to critical care on mortality for deteriorating ward patients.


The study was carried out in acute NHS hospitals in the UK. We performed a prospective cohort study of consecutive ward patients assessed for critical care. Prompt admissions (within 4 h of assessment) were compared to a ‘watchful waiting’ cohort. We used critical care strain (bed occupancy) as a natural randomisation event that would predict prompt transfer to critical care.


A total of 12,380 patients from 48 hospitals took part in the study. There were 2411 (19%) prompt admissions and 9969 (81%) controls. Prompt admissions were less frequent as strain increased from low (22%), to medium (15%) to high (9%); the median delay to admission was 3, 4 and 5 h respectively.

Prompt admission reduced 90-day mortality by 7.4% overall, and 16.2% for those recommended for critical care.


After allowing for unobserved prognostic differences between the groups, we find that prompt admission to critical care leads to lower 90-day mortality for patients assessed and recommended to critical care.


Who led the study?

Dr Steve Harris, London School of Hygiene & Tropical Medicine

This study was funded by the Wellcome Trust (Project: 088613/Z/09/Z) and ICNARC


Grieve R, O'Neill S, Basu A, Keele L, Rowan KM, Harris S. Analysis of Benefit of Intensive Care Unit Transfer for Deteriorating Ward Patients: A Patient-Centered Approach to Clinical Evaluation. JAMA Netw Open 2019; 2(2):e187704. http://dx.doi.org/10.1001/jamanetworkopen.2018.7704

Harris S, Singer M, Sanderson C, Grieve R, Harrison D, Rowan K. Impact on mortality of prompt admission to critical care for deteriorating ward patients: an instrumental variable analysis using critical care bed strain. Intensive Care Med 2018; . http://dx.doi.org/10.1007/s00134-018-5148-2