Patient Deterioration

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Early Detection and Response to Patient Deterioration in General Care

Identifying Patient Deterioration

Early identification of patient deterioration is key to intervening for serious conditions like sepsis. However, early indicators can present subtly, making detection difficult and subjective.

Adding complexity, there are often several signs or symptoms that—when they present together—can indicate the onset of a condition far more serious than what may be diagnosed by just looking at one of those signs or symptoms individually. Connecting the dots to see the complete picture becomes vital to enabling faster, more informed decisions on providing care.

General care floors are faced with several unique challenges in early detection of patient deterioration.

  • Patient acuity levels are rising, but staff-to-patient ratios generally are not.
  • A wider range of staff members, with varying levels of clinical training and experience, are taking patient vital signs.
  • Some important indicators of deterioration are not consistently part of routine vitals acquisition (e.g., respiratory rate, Is & Os, level of consciousness).
  • Vitals are not typically monitored continuously in this setting. Rather, they are spot-checked during rounds every four to six hours, depending on the patient. Time spent assessing the patient during those visits to the bedside becomes critical in collecting comprehensive information and making it actionable so that clinicians can react quickly in order to impact patient outcomes.

How can general care departments improve early detection without drastically disrupting existing clinical workflows?

The Importance of Early Detection

Research suggests that the signs and symptoms of clinical deterioration can be detected as early as six to eight hours before an event or arrest.1 However, physiological signs and symptoms of clinical deterioration can be difficult to detect in early stages.

  • Deterioration in a patient’s clinical condition frequently occurs over several hours before a critical event, providing hospital staff with a potential window of opportunity for intervention if detection of signs and symptoms occurs early.
  • Evidence-based practices to address early clinical deterioration include implementation of a rapid response team (RRT).
  • Quickly providing clinical caregivers with intelligently filtered information regarding specific patient conditions at the bedside can improve clinical decision support.
  • To aid in early detection, track and trigger methods (TTMs) assign a number score to specific signs and symptoms the patient may be either exhibiting or verbalizing.

The use of early warning scores—especially automated scores, as opposed to manual calculations—has been shown to improve effectiveness.

  • Nurses who used analytic decision-making activated Rapid Response Teams (RRTs) about twice as much as those using their intuition.2
  • Modified Early Warning Score (MEWS) calculations three times per day have been shown to result in two times as many RRT calls and decrease the number of ICU transfers by 40%.3
  • A pediatric unit’s implementation of a Pediatric Early Warning Score (PEWS) resulted in 85% of children with PEWS ≥3 improving their condition within 24 hours of a rapid medical intervention.4

A Solution for Improving Detection and Assisting in Faster Care Decisions

It can seem daunting to incorporate a process for collecting the information important to detecting patient deterioration—and put it to use to aid in clinical decision support. An approach to consider is making this an integral and intuitive part of the vital signs collection process that clinicians perform every day.

Welch Allyn Connex® vital signs devices can help hospitals combine vital signs measurement with the collection of additional patient observational information—all in a single workflow.

  • Vital signs and additional collected information are automatically calculated to generate an overall patient score—directly on the device at the bedside.
  • Clinicians are prompted with messages providing specific response actions based on the patient score and your facility’s protocols.
  • Complete information can then be sent directly to the patient’s record in the EMR.

Summary

As med/surg departments continue to care for higher-acuity patients, they need intuitive tools to help them identify signs of patient deterioration—and align with existing workflows. The use of automated early warning scores, such as those featured in Welch Allyn Connex vital signs devices, can help provide the timely decision support clinicians need to respond to patient changes right at the bedside.

 

References

Utilization of Electronic Modified Early Warning Score to Engage Rapid Response Team Early in Clinical Deterioration; Melody A. Rose, DNP, RN; Lee Ann Hanna, PhD, RN; Sareda A. Nur, MD; Constance M. Johnson, PhD, RN. Journal for Nurses in Professional Development & Volume 31, Issue 3.

Parker, C. J. (2014). Decision-making models used by medical-surgical nurses to activate rapid response teams. MedSurg Nursing, 23(3), 159-164.

Ludikhuize, J., Borgert, M., Binnekade, J., Subbe, C., Dongelmans, D., & Goossens, A. (2014). Standardized measurement of the Modified Early Warning Score results in enhanced implementation of a Rapid Response System: A quasi-experimental study. Resuscitation, 85(2014): 676-82.

Ennis, L. (2014). Paediatric early warning scores on a children’s ward: a quality improvement initiative. Nursing Children and Young People, 26(7): 25-31.

 

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