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Evidence: ‘Between the Flags’ approach to recognising patient deterioration
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Evidence: ‘Between the Flags’ approach to recognising patient deterioration

by Will DunlopAugust 16, 2018no comment
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Diagnostic: In-house Ultrasound Training Program for EM Registrars

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Evidence: Scribes increase medical productivity and shorten patient emergency stays
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Innovation: Using Visual Analogue Scales to Measure Patient Experience

by Keith JoeFebruary 18, 2019no comment

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All, Evidence, Resuscitation,

Evidence: ‘Between the Flags’ approach to recognising patient deterioration

by Will DunlopAugust 16, 2018no comment
qhc-2014-September-23-9-714-F2.large_

Recognising patient deterioration early is critical to preventing or preparing for adverse events such as cardiac arrest. When unrecognised patient deterioration was identified as a contribution to unexplained patient deaths, the Clinical Excellence Commission worked with clinicians, managers and administrators to develop a two-tiered warning system. Vital signs are recorded and tracked over time in a colour coded chart with protocols triggered when any vital sign breeches a set parameter. A vital sign falling into the yellow zone once triggers a clinical review with a nurse in charge. Any deviation into a red zone initiates a clinical review with the treating physician. This is a similar logic to the development of MET warning systems on ward. Over the 5 year trial period, clinical reviews were initiated twice as often, and cardiac arrests reduced by half.

Resp changes in patient deterioration

The response to introducing the two-tiered warning system was well received with 82% of staff surveyed agreeing that it increases patient safety. Feedback from nursing staff suggest it gives them the confidence to address their concerns about patient deterioration to physicians without feeling like they are interrupting unnecessarily.

Benefits:

  • Allows a platform for review of patients based on an evidence-based early warning trigger system
  • Gives an objective threshold that identifies patient deterioration, reducing bias and concerns of ‘bothering’ the consultant
  • The graphical presentation of vital signs shows trends more clearly, allowing easier interpretation
  • Leads to better outcomes for patients

Limitations:

  • Individual parameters would need adjustment for patients with chronic changes in vital signs (i.e. modified MET criteria)
  • Adjustments ought to be considered for patient deterioration in those with Not For Resuscitation orders

For more information:

  • See the Clinical Excellence Commission page, Between the Flags
  • View the original research article published in the International Journal of Quality in Health Care

Evidence: ‘Between the Flags’ approach to recognising patient deterioration

Clinical Excellence Commission, Rawson Place, Sydney NSW
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Between the FlagsPatient DeteriorationVital Signs

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It’s hard to define exemplar or World Class Emergency Medicine because aspects exist in many departments, but are not all present in one. The Best of Emergency Medicine brings together the best of patent care, design, and technology. It draws from real world emergency medicine examples put forward by the people who live and breathe them; the people who really know what works and what doesn’t. In sharing that experience, the Emergency Medicine community as a whole can lift the standards of care.

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Most Popular

  • Evidence: ‘Between the Flags’ approach to recognising patient deterioration

    Evidence: ‘Between the Flags’ approach to recognising patient deterioration

    August 16, 2018
  • Diagnostic: In-house Ultrasound Training Program for EM Registrars

    Diagnostic: In-house Ultrasound Training Program for EM Registrars

    January 14, 2019
  • Evidence: Scribes increase medical productivity and shorten patient emergency stays

    Evidence: Scribes increase medical productivity and shorten patient emergency stays

    February 1, 2019
  • Innovation: Using Visual Analogue Scales to Measure Patient Experience

    Innovation: Using Visual Analogue Scales to Measure Patient Experience

    February 18, 2019
  • Perspective: Decontamination Isolation Resuscitation Room

    Perspective: Decontamination Isolation Resuscitation Room

    February 11, 2019
  • Innovation: Medical Scribes in Australian Emergency Departments

    Innovation: Medical Scribes in Australian Emergency Departments

    October 15, 2018

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