title: Recognition and communication of patient deterioration in a regional hospital: a multi-methods study.
abstract: OBJECTIVE
  In this study we aimed to identify the cues that ward nurses and doctors use to identify patient deterioration and, secondly, examine the assessment and communication of deterioration in patients on acute wards of a regional hospital.
  
  
  METHODS
  Mixed methods case study design in a 220 bed regional hospital. Case studies originated from patients admitted unexpectedly to ICU from general wards (n=17). Data collection occurred within 72 h of the patient's admission to ICU. Interviews with 11 nurses and 14 doctors, and chart audit of 17 patient records for the 24 h prior to ICU were undertaken.
  
  
  RESULTS
  The results demonstrate reliance on vital signs for nurses and doctors for initial identification of patient deterioration. Subsequent to this, nurses relied on assessment of the patient's physical capabilities whilst doctors undertook additional clinical investigations. Admission category and co-morbidities increased clinicians' identification of deterioration but the extent of assessment was dictated by 'usual practice' for the regional hospital, the ward or particular patient category. A lack of timely referral to more senior clinicians was identified. Chart audit found that 13 (76%) patients had clinical markers prior to ICU admission and 10 (56%) had these markers for >2h in the previous 24h.
  
  
  CONCLUSIONS
  This study highlights inadequate communication between clinicians and lack of process for ensuring timely management when patients deteriorate in a regional hospital. The use of casual or locum staff who are less familiar with the clinical culture of regional hospitals may influence the recognition of, and response to, deteriorating ward patients.
authors.affiliation: La Trobe University, PO Box 199, Bendigo, Vic. 3552, Australia. r.endacott@latrobe.edu.au
authors.forename: Ruth
authors.initials: R
authors.lastname: Endacott
authors.forename: Tracy
authors.initials: T
authors.lastname: Kidd
authors.forename: Wendy
authors.initials: W
authors.lastname: Chaboyer
authors.forename: John
authors.initials: J
authors.lastname: Edington
mesh_terms: D001315:Australia; D015400:Clinical Nursing Research; D003142:Communication; D003422:Critical Care; D003463:Cues; D018450:Disease Progression; D006767:Hospitals, District / Q000458:organization & administration; D006801:Humans; D007400:Interprofessional Relations; D009730:Nursing Assessment; D015279:Organizational Culture; D010348:Patient Care Team; D012017:Referral and Consultation; D055986:Vital Signs