Elsevier

Resuscitation

Volume 65, Issue 2, May 2005, Pages 149-157
Resuscitation

The prevalence of recordings of the signs of critical conditions and emergency responses in hospital wards—the SOCCER study

https://doi.org/10.1016/j.resuscitation.2004.11.017Get rights and content

Abstract

Objective:

To estimate the prevalence of recordings in case notes of disturbed physiological variables in adult admissions in general hospital wards.

Design and setting:

Retrospective cross-sectional survey of 3160 admissions in general wards in five hospitals in a 14-day period.

Main outcome measures:

Recordings of 26 potential early signs (ES) and 21 potential late signs (LS) of critical conditions. Eight late signs were classified as Liverpool Hospital Equivalent Calling Signs (LES).

Results:

54.7% admissions had at least one recording of early signs, 16.0% late signs and 6.4% LES. When ranked in order of recordings per 100 admissions, the top five ES were SpO2 90–95% (193.7), systolic blood pressure (SBP) 80–100 mmHg (85.2), pulse rate 40–49 or 121–140 b/min (32.0), SBP 181–240 mmHg (23.0) and “Other” (22.1) (mainly breathlessness or temperature >38 °C). The top five LS were SpO2 < 90% (31.5), pulse rate <40 or >140/min (6.6), SBP <80 mmHg (4.2), GCS ≤8 (3.8) and unresponsiveness to verbal commands (2.4). There were average signs per admission of ES 4.4, LS 0.6 and LES 0.19. Although there were differences in rates of recordings of signs across the five hospitals, the patterns of top 10 most frequent were similar.

Conclusions:

There was a high incidence of recordings of disturbed physiological variables in general ward patients. Changes to hospital emergency response systems to include rapidly responding teams to patients with the signs of developing critical conditions should be supported by training programmes for ward staff on the early recognition and management of patients with the warning signs.

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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    Citation 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.

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