Safety and Quality > Our Work > Recognising and Responding to Clinical Deterioration > Observation and Response Charts > Development of the Evidence-based Adult General Observation and Response Charts

From a patient safety perspective, it would be hoped that there could eventually be one standard observation and response chart for Australia, mirroring the success of the National Inpatient Medication Chart. For this to occur, however, there needs to be more definitive evidence published about track and trigger systems, particularly regarding the benefits of one system over another. While the Commission will continue to monitor this issue, at present the aim of this project is to ensure that the benefits of good design are incorporated into observation charts, irrespective of the type of track and trigger system in use.

Development of observation and response charts

In 2010 a research project was conducted by the School of Psychology at the University of Queensland, funded by Commission and the Patient Safety and Quality Improvement Service of Queensland Health. The project involved a number of activities, including a heuristic analysis of 25 observation charts, a survey of clinicians about observation charts, and a comparison of performance of a small number of charts in a simulated environment.

The aims of the project included:

  1. A comparison of a range of existing observation charts to identify which charts were best for ease and accuracy of recording vital signs, and the likelihood of detecting deterioration in those vital signs
  2. Examination of performance using the charts under different conditions
  3. Creation and evaluation of a new chart that took into account the best features of the existing charts
  4. Provision of recommendations about the best observations chart for identifying deterioration based on human factors evidence.

Reports of the project are available for download.

Human factors research regarding observation charts: Research project overview (PDF 972KB)
This report provides an overview of the project that examined the design and use of observation charts in recognising and managing patient deterioration, including the design and evaluation of a new adult observation chart that incorporated human factors principles.

Heuristic analysis of 25 Australian and New Zealand adult general observation charts (PDF 3,028 KB)
The first phase of the project was a heuristic analysis of 25 existing observation charts. The heuristic analysis identified design and usability problems associated with the observation charts.

An online survey of health professionals: Opinions regarding observation charts (PDF 4,025 KB)
This report provides the results of a survey of health professionals about the design of observation charts and specific questions about nine observation charts.

The Development of the Adult Deterioration Detection System (ADDS) chart (PDF 1,575 KB)
This report describes the development of the ADDS chart.

Detecting abnormal vital signs on six observation charts: An experimental comparison (PDF 2,370 KB)
This report describes an experimental study focussed on error rates and response times of individuals when classifying physiological data presented on six charts as “normal” or “abnormal”.

Recording patient data on six observation charts: An experimental comparison (PDF 2,720 KB)
This report describes a second experimental study focussed on data-recording errors made by individuals when recording observations on six charts.

 ADDS charts

One of the main outputs of the human factors research project was the development of the two Adult Deterioration Detection System (ADDS) observation and response charts. Two versions of the ADDS chart were developed: one with a look-up table that takes into account the patient’s usual systolic blood pressure, and one without this table.

These charts were developed primarily from the charts in place in the ACT (Compass) and at The Prince Charles Hospital in Brisbane for adult general observations. They incorporate an aggregate weighted scoring system and four graded responses to abnormality. The ADDS chart was found to perform better than other selected examples of common chart types in simulation experiments.

Single parameter system charts

Single parameter observation and response charts were developed by the University of Queensland using the human factors design principles that guided development of the ADDS charts. These charts varied in the number of response categories included.

Two versions of the single parameter chart have been developed: one with two response categories and the other with four.

A single parameter, single response chart has been discontinued as there is now some evidence that graded response systems are preferable for patient safety. The Commission does not recommend the use of single response charts.

Observation and response chart usability testing and piloting: research project

The University of Technology, Sydney, under contract to the Commission, has undertaken a two part research project to test user acceptance and pilot the observation and response charts in practice.

The report on the initial phase of the research examining the usability of the single parameter and ADDS observation charts (PDF 5.4MB) is available for download.

The report on the pilot testing of the charts (PDF 4.63MB) in nine Australian hospitals is available for download.