What hospitals mean when they list a patient's condition Critical information Terms can be vague, even misleading

November 13, 1990|By Phyllis Brill | Phyllis Brill,Evening Sun Staff

WHAT DOES it mean when you hear that a dear friend has had a heart attack and is in the hospital in critical condition? Just how bad is critical? You might call the hospital the next day and be told his condition is stable. Does that mean he is out of danger now?

Perhaps you read about an accident on I-95 in which three local teen-agers are hurt. The paper says one of the passengers was hospitalized in critical condition. The next day you read that the teen's condition is guarded. Does that mean he is getting better or worse?

People are understandably curious and concerned when someone they know and care about has been admitted to the hospital. They want to be informed about how a patient is doing, and indeed if they are family they deserve as much information as they can get.

Maryland hospitals have cooperated by adopting a rough glossary of terms, devised in cooperation with the Maryland Hospital Association, to describe a patient's condition. These few key adjectives -- released to the public through the media or through hospital information desks-- are intended to satisfy the needs of friends, relatives and the curious public.

But the terms used to describe a patient's condition can be vague, simplistic and even misleading. And hospital personnel xTC agree that they are not meant to be medically definitive.

"In reality, doctors don't make their rounds saying this patient is now in fair condition, this one is critical and so forth," says Dr. William Davidson, head of the intensive care unit and chief of pulmonary medicine at Mercy Hospital.

In most hospitals, patient conditions are generally reported by nurses in each unit once a day (usually at midnight or 7 a.m.) based on information on the patient's chart, the care and observation of the patient over the last 24 hours and consultation with the physician.

The condition becomes part of a daily census report that eventually is relayed to an information desk, which takes calls from outside the hospital.

Here are the patient conditions generally agreed upon, as outlined in the Maryland Hospital Association handbook, and their definitions:

* Good: Vital signs such as pulse, temperature and blood pressure are stable and within normal limits. The patient is conscious and comfortable. His outlook for recovery is good or excellent.

* Fair (also satisfactory or stable): Vital signs are stable and within normal limits. The patient is conscious, but he is uncomfortable or may have minor complications. His outlook is favorable.

* Serious (also poor or guarded): The patient is acutely ill with questionable outlook. Vital signs may be unstable or not within normal limits. A chance for improved outlook.

* Critical: Questionable outlook. Vital signs are unstable or not within normal limits. There are major complications. Death may be imminent.

Obviously, some conditions are easier to determine than others, says Kathy McCullough, director of neuroscience nursing and acting director of surgical nursing at University Hospital. A patient in good condition is probably nearly ready for discharge, she says.

On the other hand, a patient in fair condition might be someone who has just gone through elective surgery. "He may be recently in post-op and may be a little uncomfortable or have a minor complication."

A patient in serious condition would be more acutely ill and his vital signs would be unstable, she says. "It might be a post-operative patient with more complications.

"Or it might be someone who has had a stroke in the last 24 hours, and you're not yet able to make a determination about his prognosis." Stroke victims are usually reported in guarded or serious condition for the first 24 hours, she says.

It's in the serious and critical range where definitions as well as interpretations can get fuzzy, medical experts agree.

Stable, for instance, is used with increasing frequency today, sometimes as a substitute for fair, but more often in conjunction with the terms serious and critical. Technically, stable means that a person's pulse, temperature and blood pressure are unchanged and within a normal range. But it also implies a leveling off, which some people mistakenly interpret as an improved outlook.

"Sometimes you'll hear that a person is in critical but stable condition," says Dr. James Ricely, chief of cardiology at Greater Baltimore Medical Center. "Well, that person could be dying of AIDS," he says. "He might be critical because he's on a respirator, but because he's had no new problems in the last 24 hours, he is stable."

Similarly, he says, "anybody who has a heart attack by definition is critical for the first 24 to 48 hours." Yet a patient's family may be told that he is stable once his vital signs have stabilized.

"But that's not necessarily positive information," says Ricely. "A critical but stable person could drop dead at any time."

Patient conditions are "extremely misleading," he says, but they are used because there is a demand for them. "People want to know something. They want an answer. The family expects one."

The word guarded is another vague description, says Davidson, but it is used for the same reason as critical but stable. A patient with a life-threatening illness whose vital signs have been stabilized and is now well-supported is still in danger, he says. "A nurse might choose to say guarded, knowing the patient is very sick but not knowing which way he will go," he says.

The thing to remember, doctors and nurses agree, is that these quick takes are not prognostic information. They do not refer to "medical conditions," and they are not meant to be conclusive.

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