Escalation of care for clinical deterioration in the ED

Mrs Vanessa Leonard-Roberts1,2, Professor Julie Considine2,3,4, Professor Judy Currey2,4
1Northern Health , Epping, Australia, 2Deakin University, Burwood, Australia, 3Eastern Health , Box Hill, Australia, 4Deakin Centre for Quality and Patient Research, Geelong, Australia

Recognising and responding to clinical deterioration is a national patient safety priority. Safety systems such as Medical Emergency Teams (METs) have been developed to ensure a prompt response to clinical deterioration and a reduction in the number of associated adverse events.

This study formed part of a larger study exploring the response of ED Nursing Shift Leaders to episodes of escalation of care for patient clinical deterioration. The aim of this study was to describe the characteristics of episodes of escalation of care for clinical deterioration that were observed during that study. Data were analysed using Statistical Package for Social Sciences (SPSS) Version 23.0. Descriptive statistics were used to summarise the study findings.

The study was conducted in an urban district ED in Melbourne, Australia. The ED had three levels of clinical deterioration, PreMET, MET and cardiac arrest, each with specific escalation of care criteria. 10 RNs participated in the study. There were 65 breaches of PreMET, MET and cardiac arrest criteria in 37 patients. Study data were collected between October and December 2015 across a variety of shifts.

Analysis of the escalations of care for clinical deterioration revealed three findings. First, of the escalations of care that came from within the ED 72.4% (n=21) were from registered nurses with postgraduate qualifications in emergency nursing. Only 6.9% (n=2) escalations came from graduate (novice) nurses. Second, escalation of care originated from all areas of the ED and not just the resuscitation area. Finally, nurse concern was a common cause for MET escalation. There were 36 MET criteria breaches, 28 PreMET criteria breaches and 1 cardiac arrest breach. The most common reason for PreMET escalation in adults was heart rate abnormality and the most common reason for MET escalation was for nurse concern followed by tachypnoea.

In conclusion, managing escalation of care for patient clinical deterioration has a direct impact on patient safety. This study provided an opportunity to increase understanding of the characteristics of escalation of care for clinical deterioration. An increased understanding of escalation of care for clinical deterioration is crucial to reduce associated adverse events and improve patient outcomes.

Vanessa Leonard-Roberts was born in Africa and spent most of her early career in the health industry working as an executive. In 2008 she moved to Australia where she completed a Bachelor of Nursing followed by a Master of Nursing Practice in 2017.