The prevalence of recordings of the signs of critical conditions and emergency responses in hospital wards—the SOCCER study☆
Introduction
Some hospitals have established medical emergency teams (MET) [1] or patient at risk teams (PART) [2] in the hope of preventing serious adverse events (SAE) in ward patients e.g. unexpected death, cardiac arrest, severe respiratory problems and/or unplanned admission to an acute care area. There is lack of agreement on the most appropriate calling criteria [3] in part because of paucity of data on the prevalence of disturbed physiological variables in hospital patients and the predictive value of the signs. This paper reports a cross-sectional study of the prevalence of recordings of disturbed physiological variables in the case notes of adult patients in the general wards in five hospitals during a 14-day period. Subsequent papers will report the incidence of SAE, the predictive values of the disturbed variables for SAE and the response of medical and nursing staff.
Section snippets
Approval for the study
Approval for the study was obtained from the Managements of five hospitals in the South East Health Area of New South Wales, Australia and the Hospital Ethics Committees.
Characteristics of the five hospitals
The characteristics of the hospitals are shown in Table 1. The hospitals selected were the facilities in the Health Area with a case mix of acute medicine and surgery without a single dominant specialty. A hospital for women's health was excluded on this criterion.
Case notes review
Two intensive care trained Registered Nurses reviewed
Number of eligible admissions
1428 beds were open in the five hospitals during the study period. Of the 4617 in-patient admissions, 3164 (68.5%) were not ruled out by exclusion criteria. Four sets of these case notes were not reviewed because relevant pages were missing from the notes, leaving 3160 admissions (3106 patients) whose case notes were reviewed.
The hospitals contributed significantly (P < 0.00001) different proportions of admissions with Hospital 5 highest (34.1%) and Hospital 4 lowest (7.0%). The difference
Discussion
This estimating of the prevalence of the recordings of the signs of disturbed physiological variables from a cross-sectional study of admissions in general wards of several hospitals is unique in its scale and its attempt to measure the prevalence of the recordings in admissions with and without serious adverse events (SAE). One previous study used the retrospective methodology of a small case-control study of patients who had suffered SAE [4] and another [5] was a cross-sectional study for
Conclusions
Our study has demonstrated a high incidence of recordings of disturbed physiological variables in general ward patients. It provides data to assist with local design of sets of calling criteria and the responses. It also provides data for the curricula design or modification of supporting training programmes such as the CCrISP [16] and ALERT [17]. In balancing the contribution of local ward responses and hospital wide responses, the issues of effectiveness and resource utilisation require
Acknowledgments
The SOCCER study was supported by a grant from South East Health Area of NSW for the salaries of the two Project Nurses for six months. The authors would like to thank the two Project Nurses, Ms. Stephanie Irwin and Ms. Alina Jovanovska for their diligent application to a difficult and tedious task. Ms. Jane Treloggen, Area Organ and Tissue Coordinator made an important contribution in the study development phase. We are grateful to the large number of medical and nursing clinicians who helped
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2018, Nurse Education in PracticeCitation Excerpt :Adult patients aged ≥18 years. Acute physiological deterioration – defined as likely to significantly deteriorate within 30 min (early warning signs) or current acute physiological deterioration (late signs) (see Table 2 for examples of clinical parameters defined by Harrison et al. (2005) which includes reported medical emergency team calling criteria) Events were excluded where patients were identified as:
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A Spanish and Portuguese translated version of the Abstract and Keywords of this article appears at 10.1016/j.resuscitation.2004.11.017.