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.
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
