title: Recognising clinical deterioration in emergency department patients.
abstract: BACKGROUND
  The use of rapid response systems such as Medical Emergency Team (MET) improves recognition and response to clinical deterioration in in-patient settings. However, few published studies have investigated use of rapid response systems in Australian emergency departments (ED).
  
  
  OBJECTIVE
  To examine the frequency, nature and outcomes of clinical deterioration in ED patients and compare the utility of hospital MET calling criteria with ED specific Clinical Instability Criteria (CIC) for recognition of deteriorating patients. The outcomes of interest were the prevalence of deterioration in ED patients, the utility of MET versus ED CIC, and the outcomes (MET activation, in-hospital mortality at 30 days) of patients who experienced deterioration during ED care.
  
  
  METHODS
  An exploratory descriptive design was used. Vital sign data were prospectively collected from 200 patients receiving ED care in the general treatment areas of regional, publicly funded health service in Victoria, Australia, during May 2012. Outcome data were collected by follow up medical record audit.
  
  
  RESULTS
  Of the 200 ED patients recruited, 2% fulfilled the study site MET criteria and 7.5% fulfilled ED CIC. The median age of patients fulfilling MET criteria was 85 years compared with a median age of 74 years for patients fulfilling the ED CIC criteria. Of the 136 ED patients admitted to in-patient wards, 5.9% required MET activation during admission and 3.7% of these MET activations occurred within 24h of emergency admission. Five percent of patients died in-hospital within 30 days of ED attendance.
  
  
  CONCLUSIONS
  ED specific criteria for activation of a rapid response system identifies more ED patients at risk of clinical deterioration. The results of this study highlight a need for EDs to implement and evaluate systems to increase recognition of deteriorating patients designed specifically for the emergency care context.
authors.affiliation: School of Nursing and Midwifery, Deakin University, Geelong, Australia. Electronic address: Jennifer.hosking@deakin.edu.au.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hosking
authors.affiliation: Eastern Health - Deakin University Nursing and Midwifery Research Centre, School of Nursing and Midwifery, Burwood, Australia.
authors.forename: Julie
authors.initials: J
authors.lastname: Considine
authors.affiliation: School of Nursing and Midwifery, Deakin University, Geelong, Australia.
authors.forename: Natisha
authors.initials: N
authors.lastname: Sands
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D016529:Emergency Nursing / Q000592:standards; D004636:Emergency Service, Hospital; D005260:Female; D057209:Hospital Rapid Response Team / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012308:Risk Management / Q000592:standards; D016896:Treatment Outcome; D014218:Triage / Q000592:standards; D014739:Victoria; D055986:Vital Signs
keywords: Emergency care; Emergency medicine; Emergency nursing; Rapid response team risk management patient safety