Julie Considine1,2,3,4, Margaret Fry5,6, Kate Curtis7,8, Ramon Z Shaban7,9,10. 1. School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia. julie.considine@deakin.edu.au. 2. Centre for Quality and Patient Safety Research, Deakin University, Geelong, Victoria, Australia. julie.considine@deakin.edu.au. 3. Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia. julie.considine@deakin.edu.au. 4. Centre for Quality and Patient Safety Research, Eastern Health Partnership, Box Hill, Victoria, Australia. julie.considine@deakin.edu.au. 5. Faculty of Health, University of Technology Sydney, St Leonards, New South Wales, Australia. 6. Northern Sydney Local Health District, St Leonards, New South Wales, Australia. 7. Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, New South Wales, Australia. 8. Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia. 9. Marie Bashir Institute for Infectious Diseases and Biosecurity, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia. 10. Western Sydney Local Health District, Westmead, New South Wales, Australia.
Abstract
BACKGROUND: Assessing and managing the risk of clinical deterioration is a cornerstone of emergency care, commencing at triage and continuing throughout the emergency department (ED) care. The aim of this scoping review was to assess the extent, range and nature of published research related to formal systems for recognising and responding to clinical deterioration in emergency department (ED) patients. MATERIALS AND METHODS: We conducted a scoping review according to PRISMA-ScR guidelines. MEDLINE complete, CINAHL and Embase were searched on 07 April 2021 from their dates of inception. Human studies evaluating formal systems for recognising and responding to clinical deterioration occurring after triage that were published in English were included. Formal systems for recognising and responding to clinical deterioration were defined as: i) predefined patient assessment criteria for clinical deterioration (single trigger or aggregate score), and, or ii) a predefined, expected response should a patient fulfil the criteria for clinical deterioration. Studies of short stay units and observation wards; deterioration during the triage process; system or score development or validation; and systems requiring pathology test results were excluded. The following characteristics of each study were extracted: author(s), year, design, country, aims, population, system tested, outcomes examined, and major findings. RESULTS: After removal of duplicates, there were 2696 publications. Of these 33 studies representing 109,066 patients were included: all were observational studies. Twenty-two aggregate scoring systems were evaluated in 29 studies and three single trigger systems were evaluated in four studies. There were three major findings: i) few studies reported the use of systems for recognising and responding to clinical deterioration to improve care of patients whilst in the ED; ii) the systems for recognising clinical deterioration in ED patients were highly variable and iii) few studies reported on the ED response to patients identified as deteriorating. CONCLUSION: There is a need to re-focus the research related to use of systems for recognition and response to deteriorating patients from predicting various post-ED events to their real-time use to improve patient safety during ED care.
BACKGROUND: Assessing and managing the risk of clinical deterioration is a cornerstone of emergency care, commencing at triage and continuing throughout the emergency department (ED) care. The aim of this scoping review was to assess the extent, range and nature of published research related to formal systems for recognising and responding to clinical deterioration in emergency department (ED) patients. MATERIALS AND METHODS: We conducted a scoping review according to PRISMA-ScR guidelines. MEDLINE complete, CINAHL and Embase were searched on 07 April 2021 from their dates of inception. Human studies evaluating formal systems for recognising and responding to clinical deterioration occurring after triage that were published in English were included. Formal systems for recognising and responding to clinical deterioration were defined as: i) predefined patient assessment criteria for clinical deterioration (single trigger or aggregate score), and, or ii) a predefined, expected response should a patient fulfil the criteria for clinical deterioration. Studies of short stay units and observation wards; deterioration during the triage process; system or score development or validation; and systems requiring pathology test results were excluded. The following characteristics of each study were extracted: author(s), year, design, country, aims, population, system tested, outcomes examined, and major findings. RESULTS: After removal of duplicates, there were 2696 publications. Of these 33 studies representing 109,066 patients were included: all were observational studies. Twenty-two aggregate scoring systems were evaluated in 29 studies and three single trigger systems were evaluated in four studies. There were three major findings: i) few studies reported the use of systems for recognising and responding to clinical deterioration to improve care of patients whilst in the ED; ii) the systems for recognising clinical deterioration in ED patients were highly variable and iii) few studies reported on the ED response to patients identified as deteriorating. CONCLUSION: There is a need to re-focus the research related to use of systems for recognition and response to deteriorating patients from predicting various post-ED events to their real-time use to improve patient safety during ED care.
Authors: Gerben Keijzers; Ogilvie Thom; David Taylor; Jonathan Knott; David McD Taylor Journal: Emerg Med Australas Date: 2013-10-09 Impact factor: 2.151
Authors: Derek P Chew; Ian A Scott; Louise Cullen; John K French; Tom G Briffa; Philip A Tideman; Stephen Woodruffe; Alistair Kerr; Maree Branagan; Philip Eg Aylward Journal: Med J Aust Date: 2016-08-01 Impact factor: 7.738