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Lives saved through focus on patient deterioration

A five-year patient deterioration programme funded by the Health Quality & Safety Commission has prevented a number of avoidable harms.

Doctor Alex Psirides, clinical lead for the patient deterioration programme says ‘In 2016 we identified that New Zealand had a problem, so we set ourselves the goal to reduce harm from failures to recognise and respond to acute physical deterioration in adult inpatients by 2021.

There are many New Zealanders alive who would have suffered avoidable deaths without the efforts of those implementing these measures to respond to patient deterioration.

We developed three workstreams that reflected key themes from feedback received from patients and their whānau: no-one noticed, no-one listened and no-one wanted all of this’, says Dr Psirides.

‘The first workstream looked at standardising recognition and response to patient deterioration. The second looked at Kōrero mai, enabling a process for patients and whānau to call for help if they are worried about becoming more unwell.

The third is about a shared goals of care approach when clinicians, patients and whānau explore patients’ values, the care and treatment options available and agree the goal of care for the current admission and if the patient deteriorates. DHBs are currently preparing for implementing shared goals of care in their hospitals.’

The programme has achieved several key milestones since 2016:

All DHBs have implemented improvements to their recognition and response systems. They all use the national adult vital signs chart with the New Zealand early warning score. This has created a clinical shared language so that when clinicians move between hospitals they know how to use this clinical tool.

A statistically significant increase by 50 percent in the national rate of rapid response team escalations (April 2018 - March 2021). This demonstrates recognition and response before a cardiopulmonary arrest.

The national in-hospital cardiopulmonary arrest rates appear to be decreasing showing outcomes moving in the desired direction.

Dr Psirides says the programme supported the Maternal Morbidity Working Group with the development of the national maternity early warning system (MEWS). The MEWS aimed to reduce harm through a nationally consistent, standardised approach to recognising and responding to acute deterioration of pregnant and recently pregnant women.

All 20 DHBs have implemented MEWS in their maternity services. Fourteen DHBs had also implemented MEWS across the whole of hospital by December 2020. The remaining DHBs will implement hospital wide by the end of 2021.

Outcome data from Auckland DHB’s implementation (an original test site for MEWS), has demonstrated a statistically significant reduction in emergency code calls for deteriorating pregnant women and cardiopulmonary arrest calls following implementation of MEWS.

‘These early results provide evidence that MEWS can detect and prevent deterioration of pregnant women and the findings have recently been published in Anaesthesia, the official journal of the Association of Anaesthetists.’

With the workstreams well established in DHBs, support for the patient deterioration programme will continue from the Commission until the end of the 2021/2022 financial year.

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