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Recognising and Responding to the Deteriorating Patient

Today's conference focuses on recognising and responding to the deteriorating patient through improving the reliability of patient observations and ensuring quality of care to reduce failure to rescue of acutely ill patients.

Chris Hancock Programme Manager 1000 Lives Improvement opens the morning by discussing 'Enabling clinical teams to improve the identification of acute deterioration and to effectively treat its causes including sepsis and AKI', covering:

  • ensuring a rapid response to the deteriorating patient: giving frontline staff permission to act 
  • the development of the Rapid Response Acute Illness Learning Set 
  • tackling acute deterioration at the front door 
  • our experience and learning from Wales: creating a National social movement


Chris comments: "It is not enough to improve.  You must show that you have improved.  Data and evidence is required
There is now a mortality review on every death in Wales
Sepsis is the major cause of 15% of deaths
Since 2011 there has been a reduction in deaths
NEWS is a better predictor than SIRS
NEWS is quick, cheap and cost effective in terms of behavior change"


Full powerpoint presentation

Pre conference abstract:

Enabling clinical teams to improve the identification of acute deterioration and to effectively treat its causes including sepsis and AKI

In October 2015 the then Deputy Welsh Health Minister announced a significant reduction in the mortality associated with two ICD 10 codes for sepsis which had occurred whilst the national Rapid Response to Acute Illness Learning Set (RRAILS) had been active. Across Wales, a country of three million people, this equated to an estimated reduction of approximately 200 deaths per year since April 2013.

In this presentation Chris Hancock, RRAILS lead, will argue that the two themes that have been essential to this improvement have been a focus upon measurement and a deliberate attempt to build a nationwide social movement.

There have been several approaches to establishing the quantitative burden of causes of acute deterioration in NHS Wales including the ‘Size of Sepsis’ survey and the spread of Acute Kidney Injury (AKI) e-alerts. It is strongly suggested though that there can be no control of outcomes without control of process reliability and that it is essential to generate and feedback on these data rapidly and for it to be owned by the clinical team.

The role of the data collector will be discussed and the concept of the Critical Care Outreach Team (CCOT) as the ‘Patient Safety Engine of the Hospital’ will be promoted.

A new approach to improving outcomes for patients with sepsis in the Emergency Department using ‘DRIPS’ meetings will be detailed as will the early findings that tackling acute deterioration at the ‘Front Door’ has a positive knock on effect for the rest of the hospital.

Lastly, the implementation of the Behavioural Insights Team acronym ‘EAST’ in the development of a national social movement will be discussed. Various low tech tools, including the ‘Wee Wheel’, ‘NEWS card’, ‘Sepsis Box’ and ‘Kidney Safe bracelet’ have been developed specifically to make it easy and attractive to ‘do the right thing’.

Underpinning the entire approach are the twin principles ‘good enough now beats future perfection’ and giving frontline staff ‘permission to act’.

Chris Hancock's Biography

Chris Hancock is a patient safety advisor and improvement leader working in the Welsh NHS. He leads the Acute Deterioration Programme and manages the Rapid Response to Acute Illness Learning Set (RRAILS), initiatives that has enabled clinical teams throughout Wales to improve the identification of acute deterioration and to effectively treat its causes including sepsis and AKI.

During the time that RRAILS has been active, mortality associated with ICD 10 sepsis codes A40/41 across Wales has reduced by 20%.

As an important step in this project, Chris facilitated the implementation of the National Early Warning Score (NEWS) as the standard in all acute Welsh hospitals as of April 2013. Wales was the first large healthcare economy to introduce NEWS.

Prior to this he led the Welsh Critical Care Improvement Programme (WCCIP) showing that reliable implementation of care bundles in all Welsh ICUs was associated with sustained reductions in central line infections.

He has sat on the Expert Advisory Groups for the NPSA Matching Michigan Study, the European Union IMPLEMENT Programme, the inaugural committee of the United Kingdom Sepsis Group (UKSG), the NCEPOD ‘Just Say Sepsis’ study advisory group and is a member of the National Outreach Forum (NOrF) Executive Board.

Chris has a background in critical care nursing and clinical education. He is particularly interested in patient safety, quality improvement, measurement, behaviour change and human factors principles.

He has been involved in the development of low tech tools and aide memoires such as the NEWS card, Wee Wheel, KidneySafe Bracelet and Sepsis Box and believes that achieving improvement often involves using ‘good enough’ tools to ‘give permission to act’ to all members of the clinical team.

He is a keen cyclist and has combined this interest with promoting Welsh Healthcare, firstly in the ‘Improvement Cycle’ in 2010 visiting all acute Welsh hospitals on a 450 mile round trip and in 2013, 2014 and 2015 on the ‘Cycle for Sepsis’ between Wales and the Houses of Parliament in London.

Concluding the morning sessions is John Welch Nurse Consultant - Critical Care University College London Hospitals NHS Foundation Trust & Member National Early Warning Score Development and Implementation Group (NEWSDIG). John delivers an important session on 'NEWS: Latest evidence and improving the effectiveness of NEWS in an NHS Trust ', and will discuss:

  • the new edition of NEWS: what has changed 
  • the latest evidence in the use of NEWS: ensuring NEWs is used properly 
  • improving the effectiveness of NEWS in an NHS Trust 
  • how to measure and improve the quality of the response to deterioration 
  • our experience of recognising and responding the deteriorating patient: what works? 

Full powerpoint presentation

John Welch's Biography:

John has degrees in psychology and in nursing.  He worked as a Staff Nurse, Charge Nurse, Senior Nurse and Lecturer in critical care through the 1990s, was then appointed to one of the first Consultant Nurse posts in the UK, and set-up one of the first Critical Care Outreach services.

John is currently Consultant Nurse at University College London Hospitals and was previously Deteriorating Patient Lead and then Clinical Lead for sepsis across thirteen UCL Partners hospitals in a NHS England funded Patient Safety Programme Breakthrough Series Collaborative – as well as former Programme Lead for Critical Care Outreach at the Department of Health Modernisation Agency.

John was the first Chair of the UK National Outreach Forum, co-wrote the Department of Health Quality Critical Care: Beyond 'Comprehensive Critical Care' report and sat on the Royal College of Physicians National Early Warning Score Design & Implementation Group.  He has been a member of the All Party Parliamentary Group on Sepsis Clinical Advisory Group and is now President of the international Society for Rapid Response Systems

In 2013, John co-wrote, developed and delivered a novel Nurse Intensive Care Skills Training programme in Sri Lanka which is now a gold standard course in that country.  He is currently co-investigator on two National Institute for Health Research studies, evaluating i) the impact of interventions aimed at recognising and rescuing deteriorating patients across the NHS, and ii) nurse-led psychological interventions for at-risk patients.  John is also co-lead of a new European Union Horizon 2020 funded programme to develop a novel, integrated system for identifying and communicating deterioration - in and out of the hospital - which will facilitate patient and carer contributions and participation too.

Future conferences of interest:

Learning from Serious Incidents: Implementing the National Guidance on Learning from Deaths
Monday 25 September 
De Vere West One Conference Centre

Towards Zero Suicide: Preventing Suicide, Saving Lives
Friday 29 September 
De Vere West One Conference Centre

Deteriorating Patient Summit
Monday 16 October 
De Vere West One Conference Centre

15 May 2017


    Partner Organisations

    The Tavistock and Portman NHS Foundation TrustInPracticeClinical Audit Support CentrePlayoutJust For Nurses
    GGI (Good Governance Institute) accredited conferences CPD Member ASGBI (Association of Surgeons of Great Britain and Ireland) professional partner BADS (British Association of Day Surgery) accredited conferences