A retrospective records review comparing the care of patients who either avoided or were admitted to an ICU following a ward-based deterioration event

Abstract

Objectives

To identify escalation success factors documented in care records of patients who triggered an Early Warning Score ≥ 7 in the ward, avoided an Intensive Care Unit admission and survived and compare these with ward patients who triggered an Early Warning Score ≥ 7, went to intensive care and died during their admission.

Methods

A multi-site, retrospective records review was conducted on 340 survivors and 50 non-survivors who were either admitted to, or who avoided intensive care.

Results

Non-survivors of deterioration tended to be older, earlier into their hospital admission, and had a greater number of co-morbidities at the time of their trigger event. Overall, superior care was observed in non-survivors when triangulating quality of care scores and escalation care quality metrics (escalation compliance, hourly observations, and medical re-evaluation). Survivors avoided an Intensive Care Unit admission through responding to ward management or being referred to a specialist team. However, 9.7 % (33/340) of survivors were still triggering at the time of discharge, and 54 % of these had either Covid-19 or a long-term cardiorespiratory condition.

Conclusions

This study found differences in how clinical staff responded to patient deterioration between survivors and non-survivors. Although non-survivors received higher-rated care and met more escalation quality indicators, their poorer outcomes were likely influenced by more severe underlying conditions. Despite both patient groups having comparable scores, staff appeared to make nuanced judgments factoring in clinical concerns not captured by the score alone (success factor).

Implications for Clinical Practice

Despite generating the same warning score values, there is wide variation in true patient acuity that only clinical staff can discriminate, and escalation protocols alone may not be advanced enough to address this subtlety.