As technological developments continue to offer patients more health care choices patient acuity increases. Patients that traditionally would have been cared for in a critical care environment are increasingly located on general wards. This change impacts on the acute care sector in a number of ways. Patients who are inpatients have more complex problems and a greater number of co-morbidities and are therefore more likely to suffer physiological deterioration. Procedures requiring inpatient stays are often more complex and associated with higher rates of mortality and morbidity. As patient acuity has increased research has highlighted that the care of the acutely ill ward patient is suboptimal. Suboptimal care implies a lack of knowledge regarding the significance of clinical findings relating to dysfunction of airway, breathing and circulation. This paper analyses the literature on the factors that contribute to suboptimal ward care of the acutely ill patient. It uses the categories proposed by McQuillan et al. [McQuillan P, Pilkington S, Allan A, Taylor B, Short A, Morgan G, et al. Confidential inquiry into quality of care before admission to intensive care. BMJ 1998;316(7148):1853-8] in relation to suboptimal ward care in an attempt to develop a conceptual analysis of the factors that influence suboptimal ward care and acutely ill ward patients. Thus, it aims to develop and enhance practitioners' knowledge and understanding of this topic and therefore improve patient care outcomes.