Consensus on predictors of clinical deterioration in emergency departments: A Delphi process study

Abstract

Clinical deterioration in hospitalised patients is often preceded by deterioration in physiological parameters. 1 In 1997, Morgan et al 2 proposed the first early warning score (EWS) system to alert clinicians to deteriorating patients using an aggregated, weighted score of vital signs. Early warning scores generally have a track (abnormal vital signs) and a trigger (predetermined calling or response criteria). 3 The predetermined calling or responses of the EWS often consist of increased observation, alerts to senior

A new situation awareness model decreases clinical deterioration in the emergency departments—A controlled intervention study

“…The study was designed to investigate whether a new SA model adding additional parameters and team risk assessments to the conventional regional EWS could reduce the proportion of CD through earlier identification of the deteriorating patient. As aforementioned, the vital signs, skin observations, dyspnea, pain, and relatives concerns were based on the results of a modified Delphi technique identifying potentially relevant and applicable predictors of CD in an adult ED population 20 ; whereas, clinical concern and patients’ concern were inspired by the Cincinnati SA model 17 . Studies in other settings have found that adding subjective parameters to EWS may lead to improved patient outcomes (eg, decrease in ICU admissions and identifying the deteriorating patient before triggering the EWS system) 17,26‐28 .…”

“…The vital signs comprising the regional EWS system, skin observations, dyspnea, pain, and relatives concerns were based on the results of a modified Delphi technique identifying potentially relevant and applicable predictors of CD in an adult ED population, 20 whereas clinical concern and patients’ concern were inspired by the Cincinnati SA model 17 …”

“…"Instinct and intuition are described as the initial part of rational and systematic decision-making and as informed by clinical expertise" p158719 and is often triggered by change in breathing, change in circulation, temperature, change in mentation, agitation, pain, unexpected trajectory, patient indicates that they feel unwell, subjective observation by nurses and knowing without a rationale. 15 The vital signs comprising the regional EWS system, skin observations, dyspnea, pain, and relatives concerns were based on the results of a modified Delphi technique identifying potentially relevant and applicable predictors of CD in an adult ED population, 20 whereas clinical concern and patients' concern were inspired by the Cincinnati SA model. 17 The nurse considered new or escalating deterioration if (1) the vital signs triggered the regional EWS (Appendix S1) and/or if (2) one of the additional five parameters was present.…”

Consensus on patient cases for hospitalised children with a high paediatric track and trigger tool score that raises no mounting concern: a Delphi process study

“…IQR and median were calculated for each patient case. A consensus for inclusion was defined by a median score and IQR of 7–9; for exclusion, a consensus was defined by a median score and IQR of 1–3 17 19 20. Non-consensus was defined as all other scores yielding reassessment in round 2, for example, a score and IQR falling within the 4–6 range or an IQR crossing the 4–6 range.…”