Devices help detect deterioration early

Of the death and severe harm incidents reported to the National Reporting and Learning System (NRLS) from acute hospitals between 1 January and 31 December 2015, 7% related to a failure to recognise or act on deterioration. In 2012 Hogan et al1 found that 26% of preventable deaths related to failures in clinical monitoring, including failure to set up systems, failure to respond to deterioration and failure to act on test results. These two data sources suggest that failures in monitoring and failure to act on test results are a major source of serious harm and preventable deaths in hospital. 

The current NHS pathway for montioring of patients vital signs requires nursing staff to record the vital signs of people in hospital at risk of deterioration and to use these data to calculate scores for each patient at that time point. The scores indicate whether the patient needs a higher level of care to prevent further worsening in their condition. According to Smith et al2 monitoring of scores, including temperature, pulse, blood pressure, respiratory rate, responsiveness and oxygen levels, can reduce the number of cardiac and respiratory arrests, length of stay, and intensive care unit admissions. 

In 2007 the National Institute for Health and Clinical Excellence (NICE) published a guideline on recognising and responding to deterioration in adults who are acutely ill in hospital.3 This recommended the use of physiological track and trigger systems to monitor all adults in acute hospital settings. These should employ multiple-parameter or aggregate weighted scoring systems, which allow a graded response. The parameters to be measured and the frequency of observation should be defined and should include a clear and explicit statement of the parameters, cut-off points or scores that should trigger a response.