title: The prevalence of recordings of the signs of critical conditions and emergency responses in hospital wards--the SOCCER study.
abstract: OBJECTIVE
  To estimate the prevalence of recordings in case notes of disturbed physiological variables in adult admissions in general hospital wards.
  
  
  METHODS
  Retrospective cross-sectional survey of 3160 admissions in general wards in five hospitals in a 14-day period.
  
  
  METHODS
  Recordings of 26 potential early signs (ES) and 21 potential late signs (LS) of critical conditions. Eight late signs were classified as Liverpool Hospital Equivalent Calling Signs (LES).
  
  
  RESULTS
  54.7% admissions had at least one recording of early signs, 16.0% late signs and 6.4% LES. When ranked in order of recordings per 100 admissions, the top five ES were SpO(2) 90-95% (193.7), systolic blood pressure (SBP) 80-100 mmHg (85.2), pulse rate 40-49 or 121-140 b/min (32.0), SBP 181-240 mmHg (23.0) and "Other" (22.1) (mainly breathlessness or temperature > 38 degrees C). The top five LS were SpO2 < 90% (31.5), pulse rate < 40 or > 140 /min (6.6), SBP < 80 mmHg (4.2), GCS < or = 8 (3.8) and unresponsiveness to verbal commands (2.4). There were average signs per admission of ES 4.4, LS 0.6 and LES 0.19. Although there were differences in rates of recordings of signs across the five hospitals, the patterns of top 10 most frequent were similar.
  
  
  CONCLUSIONS
  There was a high incidence of recordings of disturbed physiological variables in general ward patients. Changes to hospital emergency response systems to include rapidly responding teams to patients with the signs of developing critical conditions should be supported by training programmes for ward staff on the early recognition and management of patients with the warning signs.
authors.affiliation: Discipline of Anaesthetics, Intensive Care and Emergency Medicine, University of New South Wales, Sydney, NSW, Australia. dharrison@stvincents.com.au
authors.forename: Gordon A
authors.initials: GA
authors.lastname: Harrison
authors.forename: Theresa C
authors.initials: TC
authors.lastname: Jacques
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Kilborn
authors.forename: Mary-Louise
authors.initials: ML
authors.lastname: McLaws
mesh_terms: D000328:Adult; D003422:Critical Care / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data*; D008875:Middle Aged; D009517:New South Wales; D010343:Patient Admission / Q000706:statistics & numerical data*; D015995:Prevalence; D012189:Retrospective Studies; D012720:Severity of Illness Index