Study finds way to improve patient safety after admission from the emergency department

Deakin University nursing researchers have found that how a patient’s condition is treated in the emergency department can be a predictor of things going wrong when they are moved to the hospital wards.

In a landmark study published in European Journal of Emergency Medicine and Journal of Advanced Nursing, researchers with Deakin’s Centre for Quality and Patient Safety Research showed that patients with low blood pressure or abnormally rapid breathing in the emergency department (ED) are at higher risk of their condition deteriorating to the point of needing an emergency response when in the wards. They also found these patients were four times more likely to die in hospital, had 10 times more intensive care admissions and spent three days longer in hospital.

Professor Julie Considine said this Australian first study shows that patient safety could be enhanced if they were identified in the emergency department as being at risk of deterioration on the wards and their risk of deteriorating managed proactively.

“Our study was conducted against a backdrop of increased emphasis on reducing the time patients spend in emergency departments as a way of improving the quality of emergency care and reducing overcrowding,” Professor Considine said.

“Time-driven performance targets however lead to concerns that more unstable patients are transferred to the wards, which could result in increased cardiac arrests and activation of emergency response teams.

“What our research has shown is that we can use evidence to understand which patients are at risk of deterioration on the wards as they are leaving the emergency department and then direct ward resources to the patients with the greatest risk of getting sicker. Such an approach may prevent patients deteriorating to the point of an emergency call, following which one in three patients will die during hospital admission.”

The researchers analysed the records of 1980 patients across three Melbourne hospitals. They compared 660 patients transferred from the emergency department to the wards who needed emergency management of clinical deterioration by a rapid response team (RRT) during the first three days of admission with a matched control group of patients who did not have clinical deterioration on the ward.

Professor Considine said the results of the study would improve patient safety by helping nurses identify patients needing the most attention.

“Nurses are the guardians of patient safety and the professional group that carry the highest level of responsibility for the accurate measurement and interpretation of clinical data,” Professor Considine said.

“Nurses also have incredibly high workloads with some studies reporting nurses competing an average of 72 tasks per hour. Our results will enable nurses to further prevent poor outcomes by allowing objective assessment of which patients need higher levels of attention.

“We are currently testing the usefulness of our results in a new group of consecutive patients admitted from the emergency department to medical and surgical wards. We hope that we can develop easy to use criteria to identify high risk patients that can inform care planning, particularly frequency of nursing and medical assessments and early specialist referrals.”