'Changes of concern' for detecting potential early clinical deterioration: A validation study.

BACKGROUND: The criteria used for calling emergency response teams to patients at-risk of clinical deterioration in the acute care adult hospital population include the criterion 'patient of concern'. When calling teams to patients of concern, some 'changes of concern' used by nurses have been identified; however the validity of these 'changes of concern' is unknown. PURPOSE: This study aimed to determine the content validity of 'changes of concern' used by nurses to call emergency response teams. METHODS: Ten nurses who had 5 years or more experience with emergency response teams formed an expert group. This expert group examined content validity of the 'changes of concern' nurses used for calling emergency response teams using criterion, 'patient of concern' with a questionnaire based on Bausell's content validity criteria of necessity and sufficiency. Data were summarized using descriptive statistics. FINDINGS: The main findings indicate that the 10 'changes of concern' are agreed to be necessary to possibly identify early deterioration in adult patients that may require a call using criterion, 'patient of concern'. The associated factors that relate to these 'changes of concern' are also confirmed to be necessary to assess when these changes are present in patients. CONCLUSION: Assessment underpinned by these changes of concern (indicators) can provide more complete clinical information for clinicians to recognise possible early deterioration of patients and to coach others so building capacity to appropriately call emergency response teams resulting in increased patient safety. Research is indicated that further explores and identifies the use of 'patient of concern' criterion and that examines the effectiveness of clinical information being used to detect potential early clinical deterioration.

'Patients of concern' to nurses in acute care settings: a descriptive study.

BACKGROUND: Nurses are required to recognise early clinical deterioration in patients and call emergency support. Nurses often use the subjective non-specific criterion, 'concerned about the patient' as the indication for calling. No study has identified cues of relevance to this criterion. PURPOSE: The purpose of this study is to identify cues of potential early clinical deterioration used to recognise 'a patient of concern' who is not meeting the current objective physiologic emergency response team calling criteria. METHOD: An exploratory descriptive approach was used involving interviews with a purposive sample of 17 experienced registered nurses who recalled incidences of calling the team to adult patients based on the criterion, 'concerned about patient'. The transcribed audio tapes of interviews were coding to identify cues. FINDINGS: Main findings are ten identified changes of concern (cues): noisy breathing, inability to talk in sentences, increasing supplemental O(2) requirements to maintain SaO(2), agitation, impaired mentation, impaired cutaneous perfusion, not expected trajectory, new or increasing pain, new symptom, and new observation that nurses used to recognise potential early clinical deterioration. Two mediating factors were also identified that influenced the decision-making process. CONCLUSION: The ten changes of concern (cues) can be considered precursors of potential early deterioration that may assist nurses to detect patients at possible risk. Nurses are also aware that some patient groups are at higher risk as they are not able to communicate potential deterioration as perhaps other patients can. This study has only identified two patient groups and it is possible others should be considered. The availability of identified precursors indicates their validity for recognizing possible early clinical deterioration should be investigated further.