Ensuring that patients who deteriorate receive appropriate and timely care is a key safety and quality challenge. All patients should receive comprehensive care regardless of their location in the hospital or the time of day. Even though a range of systems have been introduced to better manage clinical deterioration, this area remains a high priority while patients continue to experience preventable adverse events because their deterioration is not identified or properly managed.
The Commission commenced a program of work in 2008 with the goal of improving the recognition of, and response to, clinical deterioration in hospitals and other acute care facilities. In 2010 the National Consensus Statement was endorsed by Health Ministers as the national approach for recognition and response systems in Australian acute care facilities. A summary of the findings from the 2010 survey of recognition and response systems in Australia can be found here.
More recently, the Commission has commenced a program of work about improving end-of-life care in acute hospitals.
Specific areas of work and related resources are detailed in the links below.
The Commission has undertaken a consultation about the minimum standard that should be required for competence in the skills and knowledge necessary to provide safe care to patients who deteriorate in acute care settings.
The Commission is beginning work to improve the recognition and response to deterioration in mental state in hospitalised patients. The first step in this work is the release of a scoping review exploring current policy and practice.
The National Consensus Statement sets out agreed practice for recognising and responding to clinical deterioration. A series of guides have been developed to help health service providers to identify strategies for implementing robust recognition and response systems.
The Commission has developed detailed specifications for a number of quality measures that facilities can use to review their processes and outcomes relating to recognising and responding to clinical deterioration.
The Commission is undertaking a program of work on end-of-life care in acute hospitals. Many Australians spend much of their last year of life going in and out of hospital, and more than half of those who die each year do so in acute care settings. Systems and structures for delivering safe and high quality end-of-life care should work in synergy with those for recognising and responding to clinical deterioration.
Monitoring and documenting physiological observations is a key component of recognition and response systems. The way in which observation charts are designed and used can contribute to both the poor recording of observations and failure to interpret them correctly. Five track and trigger observation and response charts (ORCs) designed using human factors principles are available from the Commission.
Fact sheets, self-assessment and planning tools, audit and evaluation tools and example resources from Australian healthcare organisations are available to support the implementation and evaluation of recognition and response systems.