Recognising and responding to clinical deterioration in acute hospitals. Recording patient-reported wellness after Martha's rule.

Abstract

Background: Early recognition of clinical deterioration is central to patient safety, yet preventable harm still occurs. UK policy emphasizes listening to patients and systematically capturing patient-reported wellness.

Aims: The aim of this study was to understand current practice for including patient and family voices in recognising and responding to deterioration, and to assess the feasibility of a structured approach to including patient-reported wellness as part of routine clinical monitoring.

Methods: A mixed-methods feasibility study of a structured approach to capturing patient assessments of wellness (the Patient Wellness Scale) across four medical wards in an acute hospital in Wales.

Findings: Healthcare staff routinely ask patients how they are feeling but documentation is inconsistent and fragmented. Testing the Patient Wellness Scale in a real-world clinical setting found it was not accessible to patients with speech and language difficulties, cognitive impairments, dementia and those who were critically unwell. In the context of staff shortages, temporary staffing and a task-based approach to care there is a risk that the Patient Wellness Scale could be implemented mechanistically.

Conclusions: How patients are feeling is widely recognised as clinically meaningful but remains poorly formalised as a safety signal. A brief, structured Patient Wellness Scale embedded within routine observations could externalise tacit knowledge, support escalation across hierarchies, and align practice with national policy. However, there are potential unintended consequences. Our research identifies important considerations for policy makers and organisations implementing national policy requirements for patient-reported wellness.