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Recognition of the deteriorating patient

Following Sir Bruce Keogh's review of 14 NHS Trusts, Buckinghamshire NHS Trust was found to have higher mortality rates than the England average. As part of a series of implementations and investigations to address this, a quality improvement project looking at clinical responses to the deterio...

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Autores principales: Spiers, Laura, Singh Mohal, Jagdeep, Pearson-Stuttard, Jonathan, Greenlee, Hannah, Carmichael, Juliet, Busher, Rebecca
Formato: Online Artículo Texto
Lenguaje:English
Publicado: British Publishing Group 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4645861/
https://www.ncbi.nlm.nih.gov/pubmed/26734344
http://dx.doi.org/10.1136/bmjquality.u206777.w2734
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author Spiers, Laura
Singh Mohal, Jagdeep
Pearson-Stuttard, Jonathan
Greenlee, Hannah
Carmichael, Juliet
Busher, Rebecca
author_facet Spiers, Laura
Singh Mohal, Jagdeep
Pearson-Stuttard, Jonathan
Greenlee, Hannah
Carmichael, Juliet
Busher, Rebecca
author_sort Spiers, Laura
collection PubMed
description Following Sir Bruce Keogh's review of 14 NHS Trusts, Buckinghamshire NHS Trust was found to have higher mortality rates than the England average. As part of a series of implementations and investigations to address this, a quality improvement project looking at clinical responses to the deteriorating patients was designed. Buckinghamshire NHS Trust utilises the National Early Warning Score (NEWS) metric for observations and escalation, and this was the standard used for the project. Episodes were eligible for inclusion if the NEWS score was increased to 5 or above. Data was collected by junior doctors from acute wards across the trust using notes and charts available. The initial cycle identified that in 57% of cases the high NEWS was escalated for review. Only half of cases were reviewed by a doctor; only a third were reviewed within an hour. In only 20% of cases were all criteria of the NEWS guidelines met. The first intervention was through education. After this, the project was completed on a monthly basis for 6 months with additional interventions introduced, including increased medical staff availability, grand round presentations, and increased outreach provision. Over this 6 month period, there was an increase to 87% of cases being reviewed by a doctor of appropriate seniority. Whilst this is a surrogate for reducing mortality and improving the clinical care given in the hospital, these results suggest successful interventions for improving clinical response to deteriorating patients across the trust. The project has recruited a new cohort of juniors to continue the quality improvement cycle.
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spelling pubmed-46458612016-01-05 Recognition of the deteriorating patient Spiers, Laura Singh Mohal, Jagdeep Pearson-Stuttard, Jonathan Greenlee, Hannah Carmichael, Juliet Busher, Rebecca BMJ Qual Improv Rep BMJ Quality Improvement Programme Following Sir Bruce Keogh's review of 14 NHS Trusts, Buckinghamshire NHS Trust was found to have higher mortality rates than the England average. As part of a series of implementations and investigations to address this, a quality improvement project looking at clinical responses to the deteriorating patients was designed. Buckinghamshire NHS Trust utilises the National Early Warning Score (NEWS) metric for observations and escalation, and this was the standard used for the project. Episodes were eligible for inclusion if the NEWS score was increased to 5 or above. Data was collected by junior doctors from acute wards across the trust using notes and charts available. The initial cycle identified that in 57% of cases the high NEWS was escalated for review. Only half of cases were reviewed by a doctor; only a third were reviewed within an hour. In only 20% of cases were all criteria of the NEWS guidelines met. The first intervention was through education. After this, the project was completed on a monthly basis for 6 months with additional interventions introduced, including increased medical staff availability, grand round presentations, and increased outreach provision. Over this 6 month period, there was an increase to 87% of cases being reviewed by a doctor of appropriate seniority. Whilst this is a surrogate for reducing mortality and improving the clinical care given in the hospital, these results suggest successful interventions for improving clinical response to deteriorating patients across the trust. The project has recruited a new cohort of juniors to continue the quality improvement cycle. British Publishing Group 2015-03-25 /pmc/articles/PMC4645861/ /pubmed/26734344 http://dx.doi.org/10.1136/bmjquality.u206777.w2734 Text en © 2015, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/http://creativecommons.org/licenses/by-nc/2.0/legalcode
spellingShingle BMJ Quality Improvement Programme
Spiers, Laura
Singh Mohal, Jagdeep
Pearson-Stuttard, Jonathan
Greenlee, Hannah
Carmichael, Juliet
Busher, Rebecca
Recognition of the deteriorating patient
title Recognition of the deteriorating patient
title_full Recognition of the deteriorating patient
title_fullStr Recognition of the deteriorating patient
title_full_unstemmed Recognition of the deteriorating patient
title_short Recognition of the deteriorating patient
title_sort recognition of the deteriorating patient
topic BMJ Quality Improvement Programme
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4645861/
https://www.ncbi.nlm.nih.gov/pubmed/26734344
http://dx.doi.org/10.1136/bmjquality.u206777.w2734
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