Early identification of patients at risk of deterioration in a surgical ward

Introduction

Publications have identified deficiencies in the quality of medical care and the problems and risks of ward care. Staff awareness of deteriorating patients as well as management and timely intervention are frequently found to be inadequate, and earlier identification has the potential to improve outcome for these patients.

Methods

Focus is on acutely admitted patients with abdominal pain in a surgical department. In order to improve our practice, we thought it important to undertake a needs assessment of the management of acutely and potentially critically ill patients. The study design was interprofessional and consisted of a retrospective audit, focus group interviews with medical and nursing staff and full scale simulation in the ward.

Results

From the audit we identified the following problematic areas:

• Late recognition of patient deterioration

• Lack of systematic observation with specific intervals

• Lack of seeking advice early

• Discrepancies between medical and nursing reports

• Poor documentation

The focus group interviews revealed which common needs were identified as matters of concern:

• Early identification of patients at risk

• Lack of systematic observations and interdisciplinary guidelines

• Need for efficient communication and teamwork in acute settings

• Training and education of staff

Reviewing our test simulation we were confirmed of the results from the audit and the interviews and in CRM-terms in addition lack of re-evaluation and presence of fixation errors.

Conclusion

The data obtained from our survey were subsequently used to develop objectives for a curriculum to address the identified needs. We conclude that this form of needs assessment provides a useful means of identifying issues for structuring a relevant multiprofessional educational and training programme and for organizational changes.