Recognising physiological deterioration

Recognising physiological deterioration
The onset of clinical deterioration refers to the stage when the person’s clinical state becomes physiologically unpredictable and unstable. It can result in incapacity or
death within minutes or hours. Several conditions can lead to sudden and/or unexpected deterioration of patients, and clinicians must possess knowledge and clinical
experience of specific critical illness states to be able to identify key early warning signs and symptoms indicating physiological deterioration.
The clinical signs of critical illness and deterioration are usually similar regardless of the underlying cause, because they reflect compromise of major body systems. The
identification of abnormal clinical signs [together with the patient’s history, examination and appropriate investigations] is central to objectively identifying patients who are
at risk of deterioration. These signs and symptoms are often subtle and can go unnoticed. Therefore developing assessment skills that are alert to the signs and risk of
deterioration in a patient is essential in specialist clinical practice.
Learning Outcomes
Upon successful completion of this section, you should be able to:
explain the importance for the assessment of critically ill patients
describe the key elements of advanced clinical assessment
describe the principles and practice of clinical assessment
understand the importance of recognising and preventing further deterioration in patient care
Early recognition of clinical deterioration, followed by prompt and effective action, can minimise the occurrence of adverse events s
uch as cardiac arrest, and may mean that a lower level of intervention is required to stabilise a patient.
Prevention of deterioration that results in respiratory and cardiac arrest represents the most important and most effective step in the chain of survival. It is widely
recognised that cardiac arrest in patients in unmonitored ward areas most commonly occur following a period of progressive physiological deterioration rather than a
sudden unpredictable event.
The consensus statement of the Australian Quality and Safety Health Care Commission (2010) recommends that all facilities have systems in place for measurement and
documentation of vital signs and escalation of care including rapid response systems with organisational support.
Nature of the deficiencies in the recognition and response to patient deterioration often include: infrequent, late or incomplete vital signs assessments; lack of knowledge
of normal vital signs values; poor design of vital signs charts; poor sensitivity and specificity of ‘track and trigger’ systems; failure of staff to increase monitoring or
escalate care, and staff workload. There is also often a failure to treat abnormalities of the patient’s airway, breathing and circulation, incorrect use of oxygen therapy,
poor communication, lack of teamwork and insufficient use of treatment limitation plans.
One of the most important directives of the ARC Guidelines include increased emphasis on the use of ‘track-and-trigger systems’ to detect the deteriorating patient and
enable treatment to prevent in-hospital cardiac arrest in order to improve survival.
Figure 1: Early recognition and access are essential components of effective resuscitation
The Chain of Survival represents the link between the essential elements in resuscitation which, if performed effectively, can lead to an increase in the number of persons
who survive a cardiac or respiratory arrest.