![]() ![]() Aggregate scoring systems use the number and/or severity of physiological abnormalities to define the level of clinical deterioration and the corresponding escalation of care and expected response. The most common types of systems for recognising and responding to clinical deterioration are aggregate scoring or single trigger systems, and although their use has largely been reported in hospital inpatients their use in EDs is emerging in the literature. Failure to recognise and respond to clinical deterioration during emergency care increases high-mortality adverse events during emergency care and following the emergency care episode, irrespective of whether the patient is admitted to hospital or discharged. Between 36 and 71% of ED adverse events are preventable and up to one in seven ED patients have undetected clinical deterioration. During ED care, 20 to 25% of patients have one or more abnormal vital signs and between 1.5 and 23% of ED patients experience clinical deterioration that fulfils ED-specific or hospital wide RRS activation criteria. Therefore, vital sign assessment, early recognition of vital sign abnormalities and an appropriate response is fundamental to effective emergency care and optimising patient outcomes. The majority of serious in-hospital adverse events (unexpected death, cardiac arrest, unplanned intensive care admission) are preceded by vital sign abnormalities. Recognising and responding to clinical deterioration is an international patient safety priority and is an emergency care research priority. Systematic approaches for the recognition and response to clinical deterioration in ED, following the initial triage assessment have emerged over the last decade. For hospital patients, Rapid Response Systems (RRSs) provide guidance about recognising deteriorating patients and establish the standard for an expected response when deterioration occurs. ![]() EDs have improved patient outcomes through systematic approaches to assessment, risk management, and emergency care for specific patient groups, including trauma, stroke, sepsis and acute coronary syndrome. There is a need to re-focus the research related to use of systems for recognition and response to deteriorating patients from predicting various post-ED events to their real-time use to improve patient safety during ED care.Īssessing and managing the risk of clinical deterioration is a cornerstone of emergency care, commencing at triage and continuing throughout the emergency department (ED) care. There were three major findings: i) few studies reported the use of systems for recognising and responding to clinical deterioration to improve care of patients whilst in the ED ii) the systems for recognising clinical deterioration in ED patients were highly variable and iii) few studies reported on the ED response to patients identified as deteriorating. Twenty-two aggregate scoring systems were evaluated in 29 studies and three single trigger systems were evaluated in four studies. Of these 33 studies representing 109,066 patients were included: all were observational studies. ResultsĪfter removal of duplicates, there were 2696 publications. The following characteristics of each study were extracted: author(s), year, design, country, aims, population, system tested, outcomes examined, and major findings. ![]() Studies of short stay units and observation wards deterioration during the triage process system or score development or validation and systems requiring pathology test results were excluded. Formal systems for recognising and responding to clinical deterioration were defined as: i) predefined patient assessment criteria for clinical deterioration (single trigger or aggregate score), and, or ii) a predefined, expected response should a patient fulfil the criteria for clinical deterioration. Human studies evaluating formal systems for recognising and responding to clinical deterioration occurring after triage that were published in English were included. MEDLINE complete, CINAHL and Embase were searched on 07 April 2021 from their dates of inception. We conducted a scoping review according to PRISMA-ScR guidelines. The aim of this scoping review was to assess the extent, range and nature of published research related to formal systems for recognising and responding to clinical deterioration in emergency department (ED) patients. Assessing and managing the risk of clinical deterioration is a cornerstone of emergency care, commencing at triage and continuing throughout the emergency department (ED) care.
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