The Queensland Adult Deterioration Detection System (QADDS) – improving compliance to recognise deteriorating patients in an Emergency Department.

Muireann Wynne1, Joanne Farrell2,

1 Queensland Health, Emergency Department, Logan Hospital, Meadowbrook, QLD, 4131.
2 Queensland Health, Emergency Department, Logan Hospital, Meadowbrook, QLD, 4131.

Abnormalities in physiological observations are known predecessors to adverse patient events such as respiratory and cardiac arrest. Evidence suggests that many of these abnormalities and deteriorations go unreported (Mitchell Scott et al, 2015). Structured processes for recognising and responding to deteriorating emergency department (ED) patients are varied around Australia. The Queensland Adult Deterioration Detection System (QADDS) was implemented at Logan hospital emergency department (LH ED) in 2013, consistent with state wide guidelines. The QADDS tool provides nurses with a framework in which to record observations and with a prescribed escalation process to follow in the event of patient deterioration. In October 2014, the LH ED moved to a new building which led to a threefold increase in nursing staff with a dilution of specialist emergency nursing knowledge and skill mix.

Routine audits of 20 QADDS charts were carried out in LH ED in May 2015.

  • 50% of charts had observations recorded at acceptable frequency.
  • 0% of patients with a numerical score of 4-5 in the first instance had appropriate escalation or an acceptable frequency of observations.
  • 0% of patients with a numerical score of 8 or greater had appropriate escalation or observation frequency recorded.
  • 25% of patients who warranted an emergency response in the last instance had one initiated immediately.

A nursing staff survey was carried out post initial audit results to gain further insight into facilitators and barriers experienced by staff. A qualitative approach was undertaken using a paper based survey tool. A number of barriers experienced by nursing staff when attempting to escalate deteriorating patients were identified.

Further audits in 2016 displayed some improvement in compliance to the QADDS tool.

  • 60% of charts had observations recorded at acceptable frequency.
  • 50% of patients with a numerical score of 4-5 in the first instance were escalated appropriately but 0% of these had an acceptable frequency of observations.
  • 0% of patients with a numerical score of 8 or greater had appropriate escalation or observation frequency recorded.
  • 100% of patients who warranted an emergency response in the last instance had one initiated immediately.

A QADDS quality improvement project was commenced as a priority based on the results. A focus group was formed to address the recommendations of the nursing staff survey. An expression of interest was advertised and self-nominated QADDS champions were formed to be a part of the project. A set of values and role expectations for the QADDS champions were devised using a patient safety model.

The project is ongoing and post project implementation audit results are expected by the end of September 2016.


Scott, B.M., Considine, J., Botti, M. Unreported clinical deterioration in emergency department patients: A point prevalence study. Australasian Emergency Nursing Journal 2015; 18: 33-41


Muireann Wynne.
I have worked in emergency nursing for almost my whole career. I started my nursing career in Ireland in and moved to Australia 4 years ago. I have completed a post graduate and masters in emergency nursing. I currently work as a clinical nurse consultant in Logan hospital emergency department and have a background in clinical teaching and education. My area’s of interest are in nursing education and patient safety.

Joanne Farrell.
Jo has worked in many areas in her nursing career, mainly in emergency nursing. She started her career in the UK and has worked in Western Australia for a number of years before moving to Brisbane. Jo has completed her post grad and masters in emergency nursing. She has a background in nursing management and she works as a clinical nurse consultant in Logan hospital emergency department currently. Jo’s area’s of interest are in resuscitation and disaster management.

The rhythm and blues project: A proposed method of skill and knowledge maintenance in Advanced Cardiac Life Support (ACLS) training and recertification

Julie C Humphries1, Mingshuang Ding1, Hansel Addae-Bosomprah1

1 Queen Elizabeth II Jubilee Hospital, Cnr Kessels Rd & Troughton Rd, Coopers Plains  QLD 4108 Australia

Background: The Queen Elizabeth II Jubilee (QEII) hospital is an urban district hospital with an Emergency Department (ED) which has 45,000 attendances per year.  QE II ED has a simulation training faculty which delivers simulation education and the Hospital’s ACLS training program.  Our current ACLS course is a one day certification course that consists of theoretical and practical components followed by a multiple choice test at the end.

The ED, however, has a high throughput of residents and registrars who rotate from periods of 5 weeks up to 6 months.  It is not always possible to put the entire mass through the competencies of ACLS during the term.  Retention of knowledge is ACLS a problem well recognised from various studies.

A method called ‘Rhythm and Blues’ is currently employed in QEII ED.  This aids residents who are unable to attend the full day course or who have not attended any courses, to be able to confidently participate in life support events related to patient care and training.  Residents who have already attended the course ACLS participate with the view of skill and knowledge retention.

Objective: To compare the outcomes of different groups of clinicians who receive proposed ACLS training to standard ACLS training method at QE II ED.

Method: This is a cohort studies.  ED / Medical Wards/ ICU doctors and nurses who respond to Code blues and RRT and have a requirement to undergo ACLS training as per Metro South.  Each participant will be randomly assigned (Pick a straw) to The Rhythm and Blues arm of the study or the Metro South ACLS certification pathway.

As a baseline all participants will undergo the 4 hour Metro South ACLS certification course which is valid for 12 months, they will be provided with full copies of the Metro South ACLS manual for ongoing reading and referencing for underpinning knowledge.

The Rhythm and Blues arm of the study group will undergo the rhythm and Blues pathway which consists of 10minutes per week of ACLS refreshers based on the training program.

A typical Rhythm and Blues session shall begin with a quick introduction to the learning objectives for the session.  The participant is given a scenario in a simulated environment using a patient training mannequin and patient data monitoring screen.  There shall initially be a case introduction and a running rhythm which will change to different rhythms as the scenario changes.  Participants will be drilled on four to five different rhythms and scenarios per session in rapid succession with each scenario transitioning to the next with limited interruption.  The drill is expected to last not more than 10minutes using a stop clock.  If a participant “flies” through the drills for a particular session the time taken to complete the drill will be noted.  Conversely the participant may move on to the next set of drills until the 10minute mark is completed.  In effect a participant who performs very well through the course of the drill may perform as many drills as possible within the 10 minute interval.

Expected Outcomes: At this stage a pilot study looking at short and long term skill and knowledge retention using our rhythm and blues drills compared to the full day course is being developed.


Mingshuang (Monica) Ding BMid;  MMidRes;  RM ;PhD Scholar Research Nurse/Midwife at the Emergency Department | QE II Jubilee Hospital AIA (Aeromedical Innovation Australasia) as a research Consultant Awarded academic title with Griffith University as a  Lecturer with in the School of Nursing and Midwifery.

Julie Humphries BNur; M(advance practice-emergency nursing); RNNurse Educator at the Emergency Department | QE II Jubilee Hospital.

Hansel Addae-BosomprahSenior Medical Officer at the Emergency Department | QE II Jubilee Hospital.

The patient safety implications of work-stress among ED nurses

Jacqueline C. Ingram1, Trudy Dwyer2, Kerry Reid-Searl3, Tania Signal4

1 Central Queensland University, Bruce Highway, Rockhampton, QLD, 4700,
2 Central Queensland University, Bruce Highway, Rockhampton, QLD, 4700,
3 Central Queensland University, Bruce Highway, Rockhampton, QLD, 4700,
4 Central Queensland University, Bruce Highway, Rockhampton, QLD, 4700,
This presentation explores the potential patient safety implications of work-stress among ED nurses. There is no doubt that burnout, compassion fatigue and secondary traumatic stress are among the greatest threats facing ED nurses in the 21st century. Understandably, the study of work-stress among ED nurses has boomed in recent years. The majority of this research has focussed upon the undeniably common and sometimes catastrophically negative impact it has on ED nurses themselves. The negative sequelae identified by past research ranges from sleep and mood disturbance, physical and mental illness to attrition from nursing. However, there is a growing acknowledgement that work-stress among nurses also manifests in demonstrable risks and negative outcomes for patients. While no ED-specific data is currently available, past research has shown that work-stress among nurses in a variety of settings has been associated with increased morbidity and mortality, reduced quality of care and the abuse or neglect of patients by nurses. Past research has also shown that burnout among nurses is associated with reduced engagement with formal reporting processes for adverse events and near misses. From an institutional perspective this clearly undermines the capacity for the early identification and management of potential risks and the prevention of avoidable harm to patients. Unfortunately, all past research into the patient safety implications of work-stress among nursing staff appears to have been limited to an ill-defined labile notion of stress or the narrow scope of burnout. While universally applicable as a measure of work-stress across diverse occupational groups, burnout does little to account for the novel context, manifestation and consequences of work-stress among professional carers. Therefore with a focus upon professional and ethical conduct, new research has just drawn to a conclusion which applies the more holistic measure of professional quality of life to the ED context and the patient safety implications of work-stress among ED nurses.


Jacqueline is a PhD candidate through Central Queensland University with almost 20 years ED nursing experience.  Jacqueline has completed undergraduate degrees in Nursing, Health Promotion and Health Education. She received 1st class Honours for her research into the abuse of ED nurses by their clients and colleagues. Jacqueline’s key areas of interest are emergency nursing, workplace violence, professional conduct, ethical decision making and patient’s rights.

The pathway of succession plan to develop talent pool taking up the key nursing positions as vice-chairperson of department management sub-committees in the accident and emergency department of Pok Oi Hospital

Helen Y Y Leung1, S N Lee1, Billy W M Wong1, K L Ong1

1 Accident and Emergency Department, Pok Oi Hospital, Yuen Long, New Territories, Hong Kong SAR.


Department Management Committee (DMC) is the core departmental clinical management to maintain department operational effectiveness and quality of service, Under DMC, Subcommittees of various domains are chaired by assigned staff of leadership. In 2014, a structural succession planning program was firstly initiated and developed in Pok Oi Hospital (POH) Accident and Emergency Department (A&E). It was a proactive program to prepare the next batch of leaders ready to take up the role of Vice-Chairpersons of DMC subcommittee in 2016.


  1. To prepare competent and well-primed staff ready to take up the vice-chairperson positions in Subcommittee;
  2. To proactively develop a long-term strategic approach for nursing leadership capacity building to achieve success of professional and organizational workforce planning;
  3. To develop a culture that supports knowledge and skill transfer;
  4. To provide a workplace of development opportunities to attract and retain staff.


Step 1: Identify the key positions included in the succession plan

It is the focus of succession planning to maintain the operational effectiveness. In 2014, key positions to be included in the succession plan were identified in Senior Nursing Meeting for the next batch of Vice-chairpersons of the following ten subcommittees-

 Workplace Oasis & Communication
 Clinical Research
 Emergency Medicine Ward
 Inter-hospital Transfer
 Medical Equipment
 Workplace Violence
 Accreditation
 Medication Safety
 Patient Identification



Step 2: Recognize potential talents for specific positions

The performance and expertise of individual nursing officer was reviewed. Successful succession plan is based on the selection of suitable candidate to meet the competency requirement for the specific position.

Step 3: Generate staff development plan

Nursing officers were shared and advocated with the plan details. Their feedback was invited and discussed. The support from Chairperson of related DMC Subcommittees was obtained. When the successors were selected and timeline was confirmed, the succession plan was finalized for announcement in July 2014.

Step 4: Implement the succession plan

In line with the schedule and enable uninterrupted delivery of service, the present Vice-Chairperson and the successor worked together since 2015. Relevant training were arranged for the successor.

Step 5: Provide stability and seamless transition of duty

Handover duty was completed in April 2016 and continuous support was provided to the staff taken up the new roles. Progress was closely monitored

Step 6: Evaluate the outcomes


Result and Outcome

The plan began with strong staff engagement and steps to get the right person in the right place at the right time. It is not one event. For continuity of nursing leadership development, the succession planning will be operating year round and in long term as part of departmental activities.

Evaluation of the program has been starting since the Step One in 2014 and will be an ongoing process. Successors will offer helpful evaluation data if they are confident and well-prepared in their new roles after 2016.


Ms Helen Leung has been working in emergency nursing field for more than 25 years in three Accident and Emergency Departments (A&E) in Hong Kong. She is the Fellow of Hong Kong Council of Emergency Nursing, Member of Emergency Nursing Association and Hong Kong Society for Emergency Medicine and Surgery. Her present position is the Department Operations Manager of A&E in a District hospital.

“Sorry I don’t speak your language, but my phone might!”

Mrs Dale E Reading1

1 Registered Nurse, Calvary Health Care ACT, PO Box 254 Jamison Centre ACT 2614, E –

The Australian healthcare system is a dynamic web of services, providers and organisation structures; whose primary purpose to promote, restore and/or maintain health through the delivery of quality services to all people when and where they need them.

Australia is a multicultural society; this is reflected by the 136,000 people from 210 countries who became new citizens in 2014-15 (ABS, 2015). As Australia continues to expand its population; half of the new growth coming from overseas migration, which has a direct effect on the ability of healthcare services to provide adequate and appropriate care. The Australian Capital Territory has the third leading growth rate of individuals moving into its borders. The healthcare system is being actively challenged in providing high quality care for its cultural and linguistically diverse clients (CALD).  Many people living in Australia have low English proficiency, especially when it comes to communicating within the health care setting. The use of interpreting services requires organisation, which can increase wait time for patents to receive treatment, and carries with it a financial burden, which can make it less attractive to health care services.

CALD clients are an “at risk” group, because are less likely to seek primary health care on a regular basis and are less likely to seek preventative health care (Jacobs, Shepards, Suaya & Stone, 2004). They often find it difficult to find a suitable GP, who can accommodate their language and cultural requirements. It is fair to say, poor communication often results in lack of understanding about patient’s conditions and treatment regimes. This places CALD clients at a greater risk of poor health status and low health literacy (Sentell & Braun 2012). CALD clients are also at greater risk of health complications and have a lower overall satisfaction with the health care system.

There are many barriers to using traditional tools such as interpreter services, family members or friends. When a third, or outside party is involved in a discussion between patients and health care professionals there is a loss of privacy. This can cause patients to be less forthcoming about information for fear of embarrassment, breaking cultural practices or discrimination. In an emergency, it can be difficult to locate a suitable interpreter in a time critical environment. In this scenario, broken English may be used, although it carries a high risk for misinterpretation, which could lead to adverse outcomes.

As clinicians, we are faced with challenge of caring for CALD clients on a weekly, if not daily basis. The development of new applications for smart phones/tablets such as Google Translate or MediBabble provides innovative ways to overcome language barriers. Clinicians are able to converse with patients in timely manner with confidence. By utilising these tools one can help improve patient satisfaction, reduce wait times and maintain patient clinician confidentiality. However, there is some debate about the accuracy of these tools. Words can be misinterpreted by the app for another meaning, which can result in miscommunication and/or loss of information. There is a need for more research into this area because of the benefits of reducing clinical wait times and the potential for better health outcomes. In spite of this, these Apps are a great resource that are under utilised in the healthcare industry and there clinical potential warrants greater consideration.


Australian Bureau of Statistics 2015, Australian Demographic Statistics, cat. no. 1301.0, ABS, Canberra.

Jacobs, E. A., Shepard, D. S., Suaya, J. A., & Stone, E.-L. (2004). Overcoming Language Barriers in Health Care: Costs and Benefits of Interpreter Services. American Journal of Public Health94(5), 866–869.

Sentell, T., & Braun, K.L., (2012), Low health literacy, limited English proficiency, and health status in Asians, Latinos, and other racial/ethnic groups in California, Journal of Health Communication, 1782 – 99 18p. doi:10.1080/10810730.2012.712621


As a second year registered nurse, I am being constantly exposed to the diverse challenges that working in an emergency department brings. I love these challenges and the busyness it entails. I am passionate about providing quality care in a genuine manner. Prior to doing my nursing degree, I worked within the field of youth work and spent a year living remotely in an indigenous community working with indigenous youth. This was an eye opening experience to cultural differences within our nation. The increasing number of clients from culturally and linguistically diverse (CALD) backgrounds presenting to the health care reminds me of the need to be sensitive to these differences in the care I provide to my patients.

Profiling wound management in the emergency department: A descriptive analysis

Rachel Cross1,2,Natasha Jennings2, William McGuiness1, Charne Miller1

1La Trobe University, Alfred Clinical School, 99 Commercial Road Melbourne, Victoria, 3004, Australia.
2The Alfred Hospital, Emergency and Trauma Centre, 99 Commercial Road Melbourne, Victoria, 3004, Australia.

Background: In Australia, wound and skin conditions are among the top 10 patient presentations to emergency departments. Yet the service profile of wound, skin and ulcer presentations to emergency departments is an area that lacks an existing published commentary. Knowledge of these presentations would inform the allocation of resources, staff training, and, in turn, patient outcomes.

Aim: The aim of this study was to describe the frequency of wound, skin and ulcer patient presentations to one ED, to profile the most common types of wounds seen, and to appraise the discharge and referral status of this patient population. This study was conducted in one Australian emergency department.

Methods: A retrospective descriptive review was conducted of all emergency presentations including discharge and referral statuses for skin, wound and ulcer related conditions from 1st January 2014 until 31st December 2014.

Results: A total of 4231 patients presented to the emergency department for a wound, skin or ulcer complaint. Management for these conditions accounted for 7% of the total emergency presentations. Wound conditions were the most prevalent (n=3658; 86%), followed by skin (n=539; 12.7%) and decubitus ulcer and pressure area (n=34; 0.8%). Males were more likely to present for all three conditions. For all conditions, discharge to home was the most common destination. Following discharge to home, over half all patients were referred to the local medical officer.

Conclusions: The current workload for the management of wound, skin and ulcer presentations to the emergency department would suggest that these patients contribute a significant financial burden to the ED. The implications for appropriate wound management in the ED are, therefore, significant. Nursing workforce models, education and training needs to reflect the skill set required to respond to wound, skin and ulcer conditions to ensure that high quality skin and wound care continues outside of the emergency department.


Rachel Cross is a Lecturer in the School of Nursing and Midwifery for La Trobe University, Victoria, Australia. Rachel also works in a clinical capacity in one large emergency and trauma centre in Victoria. Rachel has worked in clinical and educational roles in both local and international emergency and acute care settings. Rachel’s research area of interest is patient safety at the point of emergency department discharge and the influence for the transition of patient care. Rachel is currently undertaking her PhD examining handover and clinical deterioration in emergency care transitions.

Obesity and the emergency short stay unit

Marc Marquez1, William McGuiness3, Rachel Cross1,3, Biswadev Mitra1,2

1 Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia
2 Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia
3 La Trobe University School of Nursing and Midwifery, Alfred La Trobe Clinical School, Melbourne, Australia

Objectives: To evaluate the health service requirements of obese patients admitted to an Emergency Short Stay Unit (ESSU) and specifically compare length of stay (LOS), failure of ESSU management, and rates of investigations and allied health interventions among obese and non-obese patients.

Methods: A prospective cohort study, using convenience sampling was conducted. The body mass index (BMI) of participants was calculated and those with a BMI of ⩾30 were allocated to the obese group, and those that had a BMI of <30 to the non-obese group. Data collected included demographics, admission diagnosis, time and date of ESSU admission and discharge, discharge disposition, radiological investigations, and referrals made to allied health personnel during ESSU admission.

Results: There were 262 patients that were recruited sub-grouped into 127 (48.5%) obese participants and 135 (51.5%) non-obese participants with similar sex and diagnostic category distributions. The mean LOS in ESSU was similar – 11.5 h (95% CI: 9.9–13.1) for obese patients and, 10.2 h (95% CI: 8.8–11.6) for non-obese patients (p = 0.21). Failure rates of ESSU management, defined as inpatient admission to hospital, were also similar with 29 (22.8%) obese patients admitted to hospital compared to 25 (18.5%) non-obese patients (p = 0.39). Plain X-ray requests were significantly higher among obese patients (71.6 vs 53.3%; p = 0.002), as was the rate of allied health interventions (p = 0.001).

Conclusion: There was no significant difference in inpatient admission rates or LOS between obese and non-obese patients managed in the ESSU. Provisions for increased rate of investigations and allied health interventions for obese patients may facilitate timely assessment and disposition from ESSU.


Marc Marquez is a Clinical Nurse Specialist in the area of Emergency & Trauma nursing, with a background of six years clinical experience at The Alfred Hospital’s Emergency & Trauma Centre. Marc graduated from Victoria University with a Bachelor of Nursing in 2008. He has recently completed his Master of Nursing (Emergency Care) at La Trobe University, where an original research entitled ‘Obesity and the Emergency Short Stay Unit’ has been submitted and accepted by the International Emergency Nursing Journal for publication.  Since 2008, he’s had a variety of teaching experiences throughout different course levels, ranging from Certificate 3 & 4 Health Services courses to Initial Registration Course for Overseas Nurses (IRON). Marc has also been employed as a consultant and curriculum enhancer for IRON courses, including development of assessments and marking guides. He serves as a Nursing Officer for the Royal Australian Army Nursing Corps, and has been an active serving member of the Army Reserve for ten years. With a strong passion for the development of international healthcare standards, Marc is heavily involved with the Alfred Hospital’s international programs.

Hashtag – a fresh system for emergency nursing assessment

Antony Robinson1

1 Royal Darwin Hospital, Rocklands Drive, Tiwi, NT, 0810,

The ‘Hashtag System’ is a fresh way for conceptualising and teaching the emergency nursing assessment process. It enables nurses to combine the benefit of a systematic approach with the fluid prioritisation which is the art of emergency nursing.

Models such as HIRAID have advanced the conceptualisation of the emergency nursing assessment process, but imply a linearity which can evade the frontline nurse. Hashtag seeks to take advantages of such systems but make the model more memorable, usable, adaptable and expandable for both novice and experienced emergency practitioners. The importance of synthesis is integrated into the platform, encouraging nurses to develop higher level assessment skills.

This presentation will introduce the Hashtag System and offer resources for nurses to try the system in their own practice.


Antony Robinson is the acting Clinical Nurse Consultant – Education at Royal Darwin Hospital Emergency Department. He has worked in Australia, Solomon Islands, United Kingdom, Timor Leste and Indonesia.

Expanding the horizon of work-related violence: Are we safe in our own communities?

Jacqueline C. Ingram1, Trudy Dwyer2, Kerry Reid-Searl3, Tania Signal4

1 Central Queensland University, Bruce Highway, Rockhampton, QLD, 4700,
2 Central Queensland University, Bruce Highway, Rockhampton, QLD, 4700,
3 Central Queensland University, Bruce Highway, Rockhampton, QLD, 4700,
4 Central Queensland University, Bruce Highway, Rockhampton, QLD, 4700,

Trigger Warning: Some nurses may find the participant responses reported in this presentation distressing. Attendee discretion advised. This presentation presents preliminary findings from recent Australian research and aims to challenge the mindset that work-related violence for ED nurses is something that begins and ends at the doors of our emergency departments.  Past research has shown that ED nurses have a career risk of up to 100% for violence and physical intimidation in the workplace.  Fifty per cent of all hospital-based violence occurs in the ED and in the vast majority of instances, patients are the assailants.  Emergency nurses are so frequently subjected to abuse, intimidation and harassment that we have become inured to the problem and rarely report such incidents through formal channels. But perhaps even more common than overt victimisation, is the recurrent and pervasive sense of vulnerability experienced by ED nurses both at work and in our communities.  For many of our colleagues, perhaps more so for those working in regional, rural and remote centres, the work-related vulnerability and safety infringements they experience at the hands of patients is something that may follow them home.  As readily identifiable and easily locatable members of their communities, things as simple as travelling to and from work, walking down the street, shopping for groceries, attending a sporting event or even dropping their kids at school could become hazardous.  While no ED-nurse specific data has been found, global health and safety statistics tell a cautionary tale.  Records demonstrate an overrepresentation of health care workers as victims of stalking and murder is the leading cause of work-related death for women with their exposure to volatile patients proposed as a key contributing factor. This suggests that it is no longer enough to confine our research to the violence experienced by nurses in their workplaces.  Rather it would seem prudent to expand our horizon and begin routinely exploring the broader safety-implications of our work as ED nurses both on and off duty.  Therefore, as part of a larger study encompassing ED-nurse safety, work-stress, professional conduct and conflict resolution, research is about to begin into Australian ED nurses’ experiences of abuse and intimidation at the hands of patients in our workplaces and our communities.  This component of the research focuses not only upon the frequency with which ED nurses experience direct violence and threats, but also upon the frequency with which our sense of safety is undermined by encounters with patients while on and off duty.


Jacqueline is a PhD candidate through Central Queensland University with almost 20 years of ED nursing experience.  Jacqueline has completed undergraduate degrees in Nursing, Health Promotion and Health Education. She received 1st class Honours for her research into the abuse of ED nurses by their clients and colleagues. Jacqueline’s key areas of interest are emergency nursing, workplace violence, professional conduct, ethical decision making and patient’s rights.

Does the new Sepsis 3.0 have a place in Australian Emergency Departments?

Melissa M Hanson1

1 Emergency Department, Dubbo Base Hospital, Myall Street, Dubbo, N.S.W. 2830,

The New Sepsis 3.0 poster aims to educate ED clinicians regarding the new sepsis definitions set out by the Third International Consensus Definitions for Sepsis and Septic Shock (TICDSSS) (2016), also known as Sepsis 3.0. By adding the new Sepsis 3.0 criteria to the already implemented Adult Sepsis Pathway (ASP) guidelines, it is hoped that sepsis knowledge, recognition, and treatment within Australian EDs might be improved through the presentation of new, easy to read and understand information.

The New Sepsis 3.0 poster describes the new definitions for sepsis and septic shock as defined by the TICDSSS. It also discusses why the term ‘Systemic Inflammatory Response Syndrome’ (SIRS) is now not used – the research supporting the new criteria demonstrates a link between patients admitted to critical care units with infection and new organ failure, and not meeting the SIRS criteria, and thus the inefficacy of the SIRS definition. In place of SIRS are two different sets of clinical criteria that reflect a reliable predictor of mortality – the Sequential (Sepsis-related) Organ Failure Assessment score (SOFA), and the Quick Sequential Organ Failure Assessment score (qSOFA). These scores are presented in the poster in conjunction with humorous puns, eye-catching images and matching, easy-to-remember mnemonics.

The New Sepsis 3.0 poster does not just list information – it challenges its viewers to think critically. It effectively asks the viewer, “What do you think?” For example, facts are presented that compare and contrast the SIRS criteria to the SOFA and qSOFA criteria, and the resulting outcome of mortality. Importantly, the literature discovered that within the ED environment, the qSOFA score has a greater validity for predicting mortality rate than the SOFA score, and thus the poster makes mention of the importance of qSOFA to EDs. In addition to this, some of the limitations of the Sepsis 3.0 criteria are listed, but not all, because the aim of the poster is to encourage clinicians to go back and perform their own additional research in order to make their own decision. That is why the heading at the top of the poster asks, “Which side of the sofa are you sitting on?” The poster also makes clinicians question the specificity of what is presented. For example, the SOFA and qSOFA scores may result in earlier recognition of patients who are at risk of sepsis, but this may also lead to unnecessary admissions and treatments in some patients. The specificity is not designed in the SOFA and qSOFA scores to differentiate between, for example, those patients who score a positive result in the qSOFA score, but comparatively low on a prognostic pneumonia scoring scale. These patients may be over-treated as a result, with prolonged and unnecessary stays in critical care units. Each definition and scoring criteria for sepsis, both the old and the new ones, will have its positive and negative aspects – it is up to the clinicians and their departments to research, validate evidence, and subsequently decide which criteria is best for their department and patients.

References for the poster:

[1] Singer, M., Deutschman, C. S., Seymour, C. W., Shankar-Hari, M., Annane, D., Bauer, M., . . . Angus, D. C. (2016). The third international consensus definitions for sepsis and septic shock (Sepsis-3). Journal of the American Medical Association, 315(8), 801-810.

[2] Abraham, E. (2016). New definitions for sepsis and septic shock: Continuing evolution but with much still to be done [Editorial]. Journal of the American Medical Association, 315(8), 757-759.

[3] Farkas, J. (2016, February 29). PulmCrit—Top ten problems with the new sepsis definition [Blog post]. Retrieved from

[4] Rezaie, S. (2016). Sepsis 3.0 [Blog post]. Retrieved from

[5] Edmonds, M. (2016). Sepsis 3.0 and the Quick SOFA [Blog post]. Retrieved from


Melissa Hanson is an Advanced Clinical Nurse working in the Emergency Department of Dubbo Base Hospital. She has a passion for resuscitation, sepsis, and critical care. She is currently completing her Masters Degree in Emergency Nursing, and has extensive experience in Emergency Nursing within the Sydney West LHD and Western NSW LHD. Melissa is married to police officer Scott, and they have 3 children aged 4-and-under together. In her down time, she can be found at work, buried in journal articles, or out on the family farm!