Clinical Deterioration

• Discuss early recognition of the deteriorating patient and prevention of cardiac arrest
• Review the links in the ‘Chain of Prevention’
• Outline causes of deterioration
• Discuss the Primary Survey for initial and ongoing assessment
• Discuss the priorities in an emergency
• Review the links in the ‘Chain of Survival’

Often in the clinical setting prior to a serious adverse event (e.g. cardiac arrest), patients demonstrate deterioration in the form of observable clinical signs that fall outside the normal range. The ability to identify deterioration early may improve outcomes and lessen the intervention required to stabilize patients who experience clinical deterioration.

In Australia, The National Safety and Quality Health Service Standards include Standard 8 – Recognising and Responding to Acute Deterioration. This standard outlines factors that may contribute to staff not identifying early signs of deterioration, which include:

• not monitoring physiological observations consistently or not understanding observed changes in physiological observations.
• lack of knowledge of signs and symptoms that could signal deterioration
• lack of formal systems for responding to deterioration
• lack of skills to manage patients who are deteriorating
• failure to communicate clinical concerns.

Australian Commission on Safety and Quality in Health Care, 2024

Standard 8 details four key criteria to ensure a patient’s deterioration is detected and recognized, with ensuring prompt and appropriate action taken to escalate care, these criteria are:

• Establishing and supporting recognition and response systems
• Detecting and recognising clinical deterioration and escalating care
• Responding to clinical deterioration
• Communicating with patients and carers