Recognising and responding to acute physiological deterioration

The National Consensus Statement: Essential elements for recognising and responding to acute physiological deterioration was endorsed in 2010 by Health Ministers as the national approach for recognition and response systems in Australian acute care facilities. The Consensus Statement was reviewed and updated in late 2016 and is currently under review.

The Commission also commenced work in 2012, examining strategies to improve the safety and quality of end-of-life care in hospitals. Further information on this work can be found at End-of-life care.

A guide was released in 2012 to support implementation of the National Consensus Statement: Essential elements for recognising and responding to clinical deterioration. The Consensus Statement was updated in 2016.

The tools and resources can still be used by health service providers to identify strategies for successfully implementing robust recognition and response systems to address acute physiological deterioration.

Monitoring and documenting physiological observations is a key component of recognition and response systems. An observation and response chart is a document that allows the recording of patient observations, and specifies the actions to be taken in response to physiological deterioration. 

Five track and trigger observation and response charts (ORCs) designed using human factors principles are available from the Commission.

For copies of the InDesign files, send a request via e-mail noting which chart you are interested in to: Accreditation Support

The Commission has developed a series of tip sheets highlighting different perspectives and useful tips from people implementing different aspects and different models of recognition and response systems.

In 2010 the Commission conducted a national survey about the recognition and response systems and practices in place across Australian hospitals. The results of this survey and discussion of implications for the work of the Commission is available to download:

Tools are available to help facilities to collect the data required to evaluate some of the different aspects of recognition and response systems for clinical deterioration.

Clinical deterioration audit and evaluation tools

These include:

• Rapid response survey (PDF 342KB)
• Rapid response case report (PDF 230KB)
• Observation chart audit (PDF 444KB)
• Evaluation agreement tool (PDF 258KB)

Quality measures for recognition and response systems

A series of quality measures have also been developed. These enable facilities to review their processes and outcomes relating to recognising and responding to clinical deterioration.

Facilities are not required to collect data on these measures and can choose the quality measures that best fit with their circumstances. However, the Commission suggests that all facilities should include the key measures listed below in their evaluation systems.

Facilities may choose additional measures to focus on depending on the stage of implementation of their recognition and response systems. For example, facilities could audit the documentation of core physiological observations and compliance with monitoring plans or policies when a new observation and monitoring policy is introduced.

Facilities with well-embedded systems may focus on rates of failed escalation with mortality, rapid response activation and unexpected in-hospital death as measures of ongoing performance.

Key measures

• In-hospital death rates (PDF 1.5 MB)
• Rapid response activation rates (PDF 1.5MB)
• Rates of failed escalation with mortality (PDF 1.5 MB)
• Unexpected cardiopulmonary arrest rates (PDF 1.5 MB)
• Unexpected in-hospital death rates (PDF 1.5 MB)

Additional measures

• Activation of patient, family and carer escalation (PDF 1.5 MB)
• Awareness of patient, family and carer escalation (PDF 1.5 MB)
• Clinical documentation after rapid response system calls (PDF 1.5 MB)
• Compliance with monitoring plans or policies (PDF 1.5 MB)
• Documentation of core physiological observations (PDF 1.5 MB)
• Escalation of care (PDF 1.5 MB)

A PDF that includes all of the quality measures is available here.

There are 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.

Quality measures to support evaluation

Regular review of, and action on, markers of quality of care is an integral part of quality improvement. It is important to build processes into clinical governance frameworks to allow routine collection, review and action on timely and targeted data.

The Commission's detailed specifications for quality measures  are the most useful for facilities to use to enable robust evaluation of recognition and response systems, but they are not mandatory.

See also the audit and evaluation tools above.

Audit frequency

The frequency of data reviews or audits will vary according to the measure being used and the context of the health service. For example, measures such as unexpected cardiopulmonary arrest or failed escalation with mortality might be measured monthly or quarterly in a large hospital, but only annually in a smaller day surgery hospital where such events are rare.

Audit frequency may also vary depending on the stage of implementation. For example, the documentation of core physiological observations might be audited weekly or monthly in the initial implementation phase, but only quarterly or biannually when systems are well embedded.

Quality measures aims

These quality measures have been put forward to support local evaluation and quality improvement.

They are not designed for performance monitoring or benchmarking. The Commission does not require collection of information about these measures; however, they do align with

• the National Safety and Quality Health Service Standards (second edition),
• current and proposed processes for data collection where they exist at a state and territory level
• the rapid response system indicators included in the Australian Council of Healthcare Standards Clinical Indicator Program.