This guideline covers how patients in acute hospitals should be monitored to identify those whose health may become worse suddenly and the care they should receive. It aims to reduce the risk of patients risk needing to stay longer in hospital, not recovering fully or dying. It doesn’t specifically cover the care of children, patients in critical care areas or those in the final stages of a terminal illness.


This guideline includes recommendations on:

Who is it for?

  • Healthcare professionals
  • All adult inpatients, including patients in the emergency department being admitted to hospital and those being moved between departments
  • Family and carers of adults in hospital

Is this guideline up to date?

We reviewed the evidence in March 2016. We identified no major studies that will affect the recommendations in the next 3–5 years.

Next review: 2017

Guideline development process

How we develop NICE guidelines

This guideline was previously called acutely ill patients in hospital: recognition of and response to acute illness in adults in hospital.

Your responsibility

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The application of the recommendations in this guideline is not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.

Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.

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