Patient Deterioration Programme: Recognising and responding together – New Zealand’s approach
The Health Quality & Safety Commission (HQSC) developed a 5 year programme that aimed to reduce harm from failures to recognize and respond to acute physical deterioration. To achieve this one of the initiatives was the development of patient and family escalation process called Kōrero mai/ Talk to me in all hospitals. This would improve communication between patients, family, and clinicians; supporting them to have a voice in order to raise concerns.
Designing a Patient and family escalation process
In order to develop Kōrero mai/ Talk to me a co-design approach was taken. This allowed for consumers and health care professionals toplan, develop, design, implement and evaluate the service, this allows for an equal partnership from the beginning to the end. Our current posters and business cards have been translated into 2 languages and also includes a QR Code that links to a NZSL video explaining Kōrero mai/ Talk to me. The Co design approach allows for real life stories and experiences to help influence the Kōrero mai/Talk to me process.
whānau
Whānau is the Māori language word for the basic extended family group.
Deteriorating patient
Your family member has been admitted into hospital and is undergoing treatment for an acute condition or an exacerbation of a chronic condition. However, they don’t appear to be improving and /or they could be deteriorating. This means that your loved one may not be improving despite treatment, for example they may not be receiving the right treatment like appropriate antibiotics, or it may be due to a complication of the treatment they are receiving, for example if they are on bed rest they may develop blood clots. However, on occasion, the hospital systemscan cause deterioration because of the lack of response to the signs of deterioration. Recognising signs of deterioration in a patient is crucial for healthcare providers to initiate timely and appropriate medical care to prevent further decline and potentially life threatening situations. Patients, families and whānauoften recognise of patient deterioration, even if vital signs are normal. Timely report of changes can aid in early intervention and may improve the overall outcome for your family member.
subtle signs
Patients, families and whānau often say ‘something just doesn’t feel right’, and they are often correct. One study reviewed data over a two-year period, which included 25 patient or family-activated calls. The majority of callers said, ‘something just doesn’t feel right’, with other leading reasons for calls being similar to criteria used by staff-initiated calls, such as shortness of breath and pain issues. The study concluded that the patient, family and whānau escalation system saved lives, without an overload of false positive calls.
Read more here
Rapid Response Systems (RRS)
Hospitals developed RRS in order to improve recognition and response to changes in a patient’s condition. They developed a process in which they standardised recognition of deterioration and then local hospitals developed a response to the deterioration that would allow health care professionals to escalate care to critical care teams or Rapid response teams (RRT).
RRT can also be called Medical Emergency Team (MET) and these teams will response to acute deterioration when called by the primary team. The team consists of healthcare professionals dedicated to providing rapid assessment and specialised interventions to patients who show signs of clinical deterioration outside of Intensive Care Units (ICU). The goal of early intervention during clinical deterioration is to improve patient outcomes. There are a number of ways RRTs can be called by bedside nurses, doctors and other health professionals, however, some hospitals have developed a process in which they can be called by family members.
