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Recognising & Responding to Deterioration

EXTENDED SESSION Recognising and responding to the deteriorating patient with Covid-19

Sara Blakeley, Consultant, Intensive Care Unit
Portsmouth Hospital NHS Trust 

• recognising and responding to the deteriorating patient with Covid-19: where are we now?
• the latest tools and guidance
• NEWS2, deterioration and COVID-19 patients
• clinical judgement and current issues
• moving forward

In her presentation Sara discussed the importance of thinking of sepsis and patient deterioration as a whole, not as separate pathways. She went on to look at data capture considerations for recognising and responding to deterioration. She said for capturing data you need to be clear what you mean by a deteriorating patient, for example the definition in community care may be different to hospital care.  It's also important to consider: how you capture data; what data you capture; outcomes and balancing data. Sara said it is complex and went on to explain how they did it in her trust. They looked at the number of escalations; post data capture 38% of patients were being escalated, after, this increased to 58%.  Of the remaining 42%, 25% were appropriately not seen, however 12% should have been seen by a clinician.  With this data they were able to look for themes e.g. if the occurrence was a particular ward, Sara said it's really helpful as they can track what we are doing. During Covid they have been able to keep monitoring the data and have maintained the gains, the percentage of escalations has continued to rise. 

What success factors facilitate escalation of care and how can these be applied more reliably

Jody Ede, Critical Care Nurse
Oxford University Hospital Foundation NHS Trust

• Identification of barriers and facilitators to information exchange about a deteriorating patient’s escalation of care
• a human factors approach
• success factors to facilitate escalation

Jody said we are programmed to notice uncommon or negative events, it's a natural instinct to alert to danger. To improve safety we have tried to learn from failure, but there is another way of thinking which can give an entirely different solution: Understanding the things that go right and why they go right; following the Safety-II principles of understanding success factors. Jody said there is value in looking at the patients that we are escalating as well as the ones that we're not. Let's optimise the system to give people resilience based healthcare systems. Understanding success factors is important to bring us more in line with other safety critical industries such as aviation and space travel, and research shows improvements can be made from success factors.    

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