46. Not well at all at Joyce Green Hospital !

Key phrases/words: Critical versus serious condition, Joint Casualty and Compassionate Centre, incapacitating illness or injury, critical condition, grave condition, extended visiting passes, late passes, the gate porter at Joyce Green Hospital.

No. 46

Hearing doctors and nurses - or occasionally a hospital spokesperson - describing the status of a patient on the bad-to-very-bad scale in relation to their progress is not something that we are likely ever stop hearing periodically, is it ?

But have you wondered about the terms and phrases that are used in these pronouncements. A number of things have crossed my mind recently. For example, what do the phrases “critical but stable” and “in a serious condition” really mean and how much uniformity is there in their use and finally where did they originate from ?

It seems highly likely that some of these descriptions arose from within the Armed Forces in an attempt to categorise wounded servicemen and women who were being despatched to hospitals or transferred to other centres during and after the two major World Wars.

Indeed an institution referred to as the Joint Casualty and Compassionate Centre now uses the following definitions:

“Having an incapacitating illness or injury” applies to an individual whose illness or injury requires hospitalisation but who does not warrant classification as either seriously ill or very seriously ill but whose illness or injury renders them physically or mentally unable to communicate with friends or relatives.

“Seriously ill”. This term applies to an individual whose illness or injury is of such severity that there is definitely cause for immediate concern but without there being any imminent danger to the life of the person concerned.

Finally the term “very seriously ill” is applied to an individual whose illness or injury is of such severity that his or her life is imminently endangered.

But what about some of the terms that are sometimes used within civilian health services to relatives or in public announcements when these can’t be avoided ?

As most readers will appreciate these words and phrases arise from an attempt to give the listeners a bite-sized description of the patient’s condition without breaking any confidences and without the necessity of having to describe what is actually happening in the clinical situation. Thus shorthand comes into play here and the patient's condition comes to be described as critical, serious, etc.

Being “in a critical condition” or being in a grave condition” usually means that there is a strong possibility of the patient dying within the next 24 hours even with the use of continuous intensive intervention and/or life support, whereas being “in a serious condition” seems to be used to indicate a reduced risk of death within the following 24 hours albeit that the patient still requires active intervention and close observation.

“Critical but stable” and “in a serious but stable condition” aim to be slightly more descriptive and therefore reassuring to either family members or to the media.

Interestingly, from accounts of the work of nurses who preceded many of us, it seems that it was quite normal for hospitals to keep up-to-date lists of “dangerously ill”, “seriously ill” and “critically ill” patients and also for relatives to be issued with “extended visiting passes” authorising gate-porters to allow them into hospitals outside of the otherwise very restricted visiting periods. In fact hospital personnel addressing the media can sometimes still be heard saying that “s/he is now off the critical list”.

Another type of paper “pass” that hospital gate-porters had to check in bygone days were “late passes” issued to resident nurses to allow them back into the hospital (usually "no later than 10.30 p.m.") when they had received permission from Matron or her deputy to go out for the evening !

This must have meant that the gate porters at Joyce Green Hospital were given lists of very ill patients - and of temporarily absent nurses too - and that they must have been required to check-in individuals against his lists until that moment in time when those activities disappeared from gate porters' job descriptions ?