Systems for recognition and response to deteriorating emergency department patients: a scoping review

Abstract

Background Assessing and managing the risk of clinical deterioration is a cornerstone of emergency care, commencing at triage and continuing throughout the emergency department (ED) care. The aim of this scoping review was to assess the extent, range and nature of published research related to formal systems for recognising and responding to clinical deterioration in emergency department (ED) patients. Materials and methods We conducted a scoping review according to PRISMA-ScR guidelines. MEDLINE complete, CINAHL and Embase were searched on 07 April 2021 from their dates of inception. Human studies evaluating formal systems for recognising and responding to clinical deterioration occurring after triage that were published in English were included. Formal systems for recognising and responding to clinical deterioration were defined as: i) predefined patient assessment criteria for clinical deterioration (single trigger or aggregate score), and, or ii) a predefined, expected response should a patient fulfil the criteria for clinical deterioration. Studies of short stay units and observation wards; deterioration during the triage process; system or score development or validation; and systems requiring pathology test results were excluded. The following characteristics of each study were extracted: author(s), year, design, country, aims, population, system tested, outcomes examined, and major findings. Results After removal of duplicates, there were 2696 publications. Of these 33 studies representing 109,066 patients were included: all were observational studies. Twenty-two aggregate scoring systems were evaluated in 29 studies and three single trigger systems were evaluated in four studies. There were three major findings: i) few studies reported the use of systems for recognising and responding to clinical deterioration to improve care of patients whilst in the ED; ii) the systems for recognising clinical deterioration in ED patients were highly variable and iii) few studies reported on the ED response to patients identified as deteriorating. Conclusion There is a need to re-focus the research related to use of systems for recognition and response to deteriorating patients from predicting various post-ED events to their real-time use to improve patient safety during ED care.

Predicting patient decompensation from continuous physiologic monitoring in the emergency department

“…For patients presenting without initial physiologic abnormalities, there is no standard framework for predicting subsequent decompensation or care needs [8][9][10] , and unexpected clinical decompensation can arise. Some studies have shown that up to 14.5% of ED patients experience clinical decompensation 11 , with up to 12.9% experiencing unreported decompensation (i.e., development of abnormal vital signs without clinician notification), particularly in overcrowded EDs and among elderly patients 12 .…”

Implementation evaluation of an evidence-based emergency nursing framework (HIRAID): study protocol for a step-wedge randomised control trial

“…Early recognition of, and response to, deteriorating ED patients is primarily an emergency nursing responsibility. Poor patient assessment and reassessment results in unrecognised clinical deterioration or delays to recognition and, or response to deteriorating patients 6. Despite the key role emergency nurses play in patient assessment, reassessment and safety, there is no standardised emergency nursing assessment framework in use for Australia’s 29 000+emergency nurses 7.…”