Aims: To describe the nature, frequency, and characteristics of adult critical care transfers originating from the emergency department (ED). Methods: A one year prospective regional descriptive study using multiple data sources of all critically ill adults transferred from an ED or a minor injuries unit (MIU) within the former Yorkshire Regional Health Authority Area or into a regional critical care facility if originating from an ED or MIU elsewhere. Results: 29 EDs transferred 349 adults into the regional critical care facilities. The median number of transfers per department within the region was 18 (range 1 to 42). Seventeen were transferred from outside the region. A total of 263 (75%) patients were transferred for specialist care and 76 (22%) for non-clinical reasons. Altogether 294 (84%) were admitted to intensive care or a high dependency unit at the receiving hospital. The in-hospital documented mortality rate was 26%. A total of 170 patients (49%) had traumatic pathology of which 101 were principally transferred for management of a head injury. Median time in the ED was 3 hours 5 minutes (range 11 minutes to 17 hours 47 minutes). In 146 (42%) patients the decision to transfer was primarily made by the emergency medicine clinician. A total of 251 (72%) patients were intubated. The documented critical incident rate was 15%. Conclusion: Trauma is the most common reason for transfer of the critically ill adult from the ED. A significant number of patients are transferred, however, with medical and surgical conditions and for nonclinical reasons. There continues to be problems with the quality of care that these patients receive. Emergency medicine clinicians must be actively involved in the development of regional critical care systems as a significant proportion of all critically ill adults transferred originate from the ED.T he inherent problems with the organisation and process of the transfer of the critically ill and injured are well recognised by emergency medicine clinicians within the United Kingdom. Previous publications have highlighted the deficiencies in the quality of care received during the transfer of the critically ill and injured adult. 1-3A system-wide approach has been suggested for trauma 4 and more recently by the Department of Health in the document Comprehensive critical care 5 for the critically ill adult. This document defines areas within critical care practice that need improvement. Specifically, the organisation of transfers of the critically ill, the quality of care, and the associated training of the staff involved have been highlighted. Problems with quality of care have been attributed to inadequate monitoring, 6 junior accompanying medical staff, 1 and poor pretransfer stabilisation.2 7-9 Attempts have been made to improve standards and training by providing specific training courses 10 and by developing clinical guidelines. [11][12][13] Despite this little is known about the descriptive epidemiology of this group of patients particularly those transferred from the emerge...

Direct support staff hold considerable power to increase or diminish residents' quality of life. A targeted programme addressing specific site, staff & skill issues would strengthen quality of life for these very dependent residents.

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The introduction of GRIDS for schools to review their curricula was received positively. Teachers welcomed their greater involvement in decisions and better communications. Further work was found to be needed on the processes of change in schools.

This paper arises out of wider Economic and Social Research Council funded research on the legacy of the Technical and Vocational Education Initiative(TVEI) in a national sample of original pilot schools. It describes and analyses the development of TVEI in one school over the period 1983-91 and draws on field-work at the school in 1986 and 1991. The development and demise of a radical cross-curricular course are explained. It is argued that the particular fate of the innovation was the result of the interplay between a range of system level, local 'market' and in-school factors.