Deteriorating Patient

Despite having highly qualified dedicated staff and high tech equipment, early recognition and appropriate timely response to patients that are clinically deteriorating may not always occur and could result in a missed opportunity to prevent serious morbidity or death in the acute health care setting.

Early recognition and warning systems aim to identify and intervene before a patient deteriorates.  A widely used approach in Australia is the Medical Emergency Team (MET) system, which includes staff education of the dangers of physiological instability.

NSW health has developed an education package for identifying and managing the deteriorating hospitalised patient.  The link has been developed for Nurses, Midwives, Doctors and Allied health staff to confidently identify and manage patients who are showing signs of deterioration.

DETECT = Detecting deterioration, Evaluation, Treatment, Escalation and Communicating in Teams.

DETECT was developed following the recommendations from the NSW health Greater Metropolitan Clinical Taskforce (GMCT) whose focus was on the detection and management of deteriorating patients.  The “Between the Flags” project followed by implementing the GMCT recommendations and was endorsed by Commissioner Garling in his inquiry into Acute Care Services in NSW Public Hospitals.

The inquiry was initiated because of concerns about the failure to detect and manage patients whose condition deteriorated but was not recognised to have done so while they were in a healthcare facility.  Analyses of adverse events including avoidable deaths support the need for addressing this failure to recognise the deteriorating patient.

The aim of DETECT education is to provide healthcare workers with the skills and confidence to: detect signs of deterioration in patients on wards; develop a ‘concern, communicate and care for’ approach to these patients to ensure they get simple interventions to reverse deterioration; ensure timely intervention and escalation when indicated.

Between the Flags – Keeping patients safe – A statewide initiative of the Clinical Excellence Commission


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