This action states

The health service organisation has processes for rapid referral to services that can provide definitive management of acute physical deterioration

Intent

Patients who need other services to resolve the cause of their acute deterioration are rapidly referred to these services.

Reflective questions

What services may be required by patients who acutely deteriorate but cannot be safely provided?

What referral mechanisms are in place to ensure that patients whose acute deterioration cannot be definitively managed within the health service organisation are rapidly referred to other organisations?

Key tasks

  • Map the causes of acute deterioration against the capacity of the health service organisation to provide for their definitive management
  • If the organisation is not able to provide definitive care, develop systems for rapid referral of patients with acute deterioration to other services.

Strategies for improvement

Hospitals

Definitive management means that the patient receives the best possible treatment for decisively resolving the cause of their acute deterioration. Acute deterioration may be the outcome of a disease process, medical intervention or condition that is not able to be effectively managed by the health service organisation where the patient is. This means that systems need to be developed to rapidly refer patients to other services.

Identify common causes of acute deterioration using data from the recognition and response systems. These may include common presentations and causes of acute physiological deterioration, such as1-4:

  • Airway obstruction and respiratory depression associated with issues such as neurological events or opioid overdose
  • Altered level of consciousness associated with issues such as neurological events, abnormal blood glucose or delirium
  • Respiratory distress associated with issues such as fluid overload, sepsis or exacerbations of existing lung disease
  • Arrhythmias
  • Hypotension associated with conditions such as
    • sepsis
    • dehydration
    • post-surgical bleeding
    • postpartum maternal haemorrhage
    • cardiac failure
  • Medicine side effects, interactions or related complications such as allergies or errors.

Map the common causes of acute deterioration against the capacity of the service to provide definitive management for each of them. For example, psychosis may be a relatively common cause of acute deterioration in mental state in the emergency department, but may be unable to be effectively managed in another service; a system for rapid referral to specialist mental health services would be required. Similarly, presentations of multi-organ failure associated with sepsis may be a relatively common cause of acute physiological deterioration and require a system for rapid referral to a tertiary intensive care service.

Develop processes for rapid referral between services within the health service organisation (for example, mental health services, palliative care, intensive care) and for rapid referral to external acute healthcare services. Include processes for the safe transport of patients in the referral systems. Referral to external services for definitive treatment of acute deterioration may also require referral to emergency transport services.

Day Procedure Services

Definitive management means that the patient receives the best possible treatment for decisively resolving the cause of their acute deterioration. Acute deterioration may be the outcome of a disease process, medical intervention or condition that is not able to be effectively managed by the day procedure service. This means that systems need to be developed to rapidly refer patients to other services.

Identify common causes of acute deterioration using data from the recognition and response systems. These may include common presentations and causes of acute physiological deterioration, such as1-4:

  • Post-anaesthetic airway obstruction and respiratory depression
  • Altered level of consciousness associated with issues such as neurological events or abnormal blood glucose
  • Respiratory distress associated with issues such as fluid overload or exacerbations of existing lung disease
  • Arrhythmias
  • Hypotension associated with conditions such as
    • dehydration
    • post-surgical bleeding
    • cardiac failure
  • Medicine side effects or interactions, or related complications such as allergies or errors.

Map the most likely causes of acute deterioration in the day procedure service against the capacity of the service to provide definitive management for each of them. For example, post-anaesthetic airway obstruction may be a routine scenario that is easily managed in the recovery room. However, fluid overload associated with cardiac failure may indicate serious deterioration that cannot be safely managed in the service. For these cases, develop a system for rapid referral to acute care services.

If the day procedure service is attached to an acute hospital, the system may involve referral and transfer to the affiliated emergency department. If the service is a standalone facility, an option is to rely on referral for ongoing care through emergency ambulance services.

Examples of evidence

Select only examples currently in use:

  • Audit results of the common causes of deterioration from the recognition and response systems mapped to organisational capacity
  • Policy documents about referral to other services for definitive management
  • Memorandums of understanding with external services that enable rapid referral for definitive management
  • Documented processes for safe transport to other services for definitive management
  • Evaluation of referral processes and patient outcomes, and evidence of associated quality improvement projects.

MPS & Small Hospitals

MPSs and small hospitals should:

  • Map the causes of acute deterioration against the capacity of the health service organisation to provide for their definitive management
  • If the organisation is not able to provide definitive care, develop systems for rapid referral of patients with acute deterioration to other services.

Definitive management means that the patient receives the best possible treatment for decisively resolving the cause of their acute deterioration. Acute deterioration may be the outcome of a disease process, medical intervention or condition that is not able to be effectively managed by the health service organisation where the patient is. This means that systems need to be developed to rapidly refer patients to other services.

Identify common causes of acute deterioration using data from the recognition and response systems. These may include common presentations and causes of acute physiological deterioration, such as1-4:

  • Airway obstruction and respiratory depression associated with issues such as neurological events or opioid overdose
  • Altered level of consciousness associated with issues such as neurological events, abnormal blood glucose or delirium
  • Respiratory distress associated with issues such as fluid overload, sepsis or exacerbations of existing lung disease
  • Arrhythmias
  • Hypotension associated with conditions such as
    • sepsis
    • dehydration
    • post-surgical bleeding
    • postpartum maternal haemorrhage
    • cardiac failure
  • Medication side effects, interactions, or related complications such as allergies or errors.

Map the common causes of acute deterioration against the capacity of the service to provide definitive management for each of them. For example, psychosis may be a relatively common cause of acute deterioration in mental state in the emergency department, but may be unable to be effectively managed in another service; a system for rapid referral to specialist mental health services would be required. Similarly, presentations of multi-organ failure associated with sepsis may be a relatively common cause of acute physiological deterioration and require a system for rapid referral to a tertiary intensive care service.

Develop processes for rapid referral between services within the health service organisation (for example, mental health services, palliative care, aged care, intensive care) and for rapid referral to external acute healthcare services. Include processes for the safe transport of patients in the referral systems. Referral to external services for definitive treatment of acute deterioration may also require referral to emergency transport services.

Hospitals

Definitive management means that the patient receives the best possible treatment for decisively resolving the cause of their acute deterioration. Acute deterioration may be the outcome of a disease process, medical intervention or condition that is not able to be effectively managed by the health service organisation where the patient is. This means that systems need to be developed to rapidly refer patients to other services.

Identify common causes of acute deterioration using data from the recognition and response systems. These may include common presentations and causes of acute physiological deterioration, such as1-4:

  • Airway obstruction and respiratory depression associated with issues such as neurological events or opioid overdose
  • Altered level of consciousness associated with issues such as neurological events, abnormal blood glucose or delirium
  • Respiratory distress associated with issues such as fluid overload, sepsis or exacerbations of existing lung disease
  • Arrhythmias
  • Hypotension associated with conditions such as
    • sepsis
    • dehydration
    • post-surgical bleeding
    • postpartum maternal haemorrhage
    • cardiac failure
  • Medicine side effects, interactions or related complications such as allergies or errors.

Map the common causes of acute deterioration against the capacity of the service to provide definitive management for each of them. For example, psychosis may be a relatively common cause of acute deterioration in mental state in the emergency department, but may be unable to be effectively managed in another service; a system for rapid referral to specialist mental health services would be required. Similarly, presentations of multi-organ failure associated with sepsis may be a relatively common cause of acute physiological deterioration and require a system for rapid referral to a tertiary intensive care service.

Develop processes for rapid referral between services within the health service organisation (for example, mental health services, palliative care, intensive care) and for rapid referral to external acute healthcare services. Include processes for the safe transport of patients in the referral systems. Referral to external services for definitive treatment of acute deterioration may also require referral to emergency transport services.

Day Procedure Services

Definitive management means that the patient receives the best possible treatment for decisively resolving the cause of their acute deterioration. Acute deterioration may be the outcome of a disease process, medical intervention or condition that is not able to be effectively managed by the day procedure service. This means that systems need to be developed to rapidly refer patients to other services.

Identify common causes of acute deterioration using data from the recognition and response systems. These may include common presentations and causes of acute physiological deterioration, such as1-4:

  • Post-anaesthetic airway obstruction and respiratory depression
  • Altered level of consciousness associated with issues such as neurological events or abnormal blood glucose
  • Respiratory distress associated with issues such as fluid overload or exacerbations of existing lung disease
  • Arrhythmias
  • Hypotension associated with conditions such as
    • dehydration
    • post-surgical bleeding
    • cardiac failure
  • Medicine side effects or interactions, or related complications such as allergies or errors.

Map the most likely causes of acute deterioration in the day procedure service against the capacity of the service to provide definitive management for each of them. For example, post-anaesthetic airway obstruction may be a routine scenario that is easily managed in the recovery room. However, fluid overload associated with cardiac failure may indicate serious deterioration that cannot be safely managed in the service. For these cases, develop a system for rapid referral to acute care services.

If the day procedure service is attached to an acute hospital, the system may involve referral and transfer to the affiliated emergency department. If the service is a standalone facility, an option is to rely on referral for ongoing care through emergency ambulance services.

Examples of evidence

Select only examples currently in use:

  • Audit results of the common causes of deterioration from the recognition and response systems mapped to organisational capacity
  • Policy documents about referral to other services for definitive management
  • Memorandums of understanding with external services that enable rapid referral for definitive management
  • Documented processes for safe transport to other services for definitive management
  • Evaluation of referral processes and patient outcomes, and evidence of associated quality improvement projects.

MPS & Small Hospitals

MPSs and small hospitals should:

  • Map the causes of acute deterioration against the capacity of the health service organisation to provide for their definitive management
  • If the organisation is not able to provide definitive care, develop systems for rapid referral of patients with acute deterioration to other services.

Definitive management means that the patient receives the best possible treatment for decisively resolving the cause of their acute deterioration. Acute deterioration may be the outcome of a disease process, medical intervention or condition that is not able to be effectively managed by the health service organisation where the patient is. This means that systems need to be developed to rapidly refer patients to other services.

Identify common causes of acute deterioration using data from the recognition and response systems. These may include common presentations and causes of acute physiological deterioration, such as1-4:

  • Airway obstruction and respiratory depression associated with issues such as neurological events or opioid overdose
  • Altered level of consciousness associated with issues such as neurological events, abnormal blood glucose or delirium
  • Respiratory distress associated with issues such as fluid overload, sepsis or exacerbations of existing lung disease
  • Arrhythmias
  • Hypotension associated with conditions such as
    • sepsis
    • dehydration
    • post-surgical bleeding
    • postpartum maternal haemorrhage
    • cardiac failure
  • Medication side effects, interactions, or related complications such as allergies or errors.

Map the common causes of acute deterioration against the capacity of the service to provide definitive management for each of them. For example, psychosis may be a relatively common cause of acute deterioration in mental state in the emergency department, but may be unable to be effectively managed in another service; a system for rapid referral to specialist mental health services would be required. Similarly, presentations of multi-organ failure associated with sepsis may be a relatively common cause of acute physiological deterioration and require a system for rapid referral to a tertiary intensive care service.

Develop processes for rapid referral between services within the health service organisation (for example, mental health services, palliative care, aged care, intensive care) and for rapid referral to external acute healthcare services. Include processes for the safe transport of patients in the referral systems. Referral to external services for definitive treatment of acute deterioration may also require referral to emergency transport services.

References 

  1. Endacott R, Kidd T, Chaboyer W, Edington J. Recognition and communication of patient deterioration in a regional hospital: a multi-methods study. Aus Crit Care 2007;20(3):100–5.
  2. Quach JL, Downey AW, Haase M, Haase-Fielitz A, Jones D, Bellomo R. Characteristics and outcomes of patients receiving a medical emergency team review for respiratory distress. J Crit Care 2008;23(3):325–31.
  3. Jones D, Bellomo R. Introduction of a rapid response system: why we are glad we MET. Crit Care 2006;10(1):121.
  4. Downey AW, Quach JL, Haase M, Haase-Fielitz A, Jones D, Bellomo R. Characteristics and outcomes of patients receiving a medical emergency team review for acute change in conscious state or arrhythmias. Crit Care Med 2008;36(2):477–81.