title: Unreported clinical deterioration in emergency department patients: a point prevalence study.
abstract: BACKGROUND
  Formal processes for recognising and responding to deteriorating emergency department (ED) patients are variable despite features of the ED context that may increase the risk of unrecognised or unreported clinical deterioration. The aim of this study was to determine the frequency and nature of unreported clinical deterioration in emergency care.
  
  
  METHODS
  A prospective, exploratory descriptive design was used. Data were collected during nine point prevalence surveys (PPS) from 1 May to 30 June 2009 at an urban district hospital in Melbourne Australia. Patients present in ED cubicles during the PPS (n=186) were included in the study.
  
  
  RESULTS
  Unreported clinical deterioration occurred in 12.9% of patients (n=24/186). Unreported clinical deterioration was more common when: (i) patients aged ≥65 years comprised >50% of patients within the ED; (ii) occupancy of the resuscitation, monitored or general adult cubicles was >50%; and (iii) the proportion of patients requiring treatment within 30 min (Australasian Triage Category 1, 2 or 3) was ≤50% of the total ED population.
  
  
  CONCLUSIONS
  Unreported clinical deterioration is an important quality indicator of emergency care. The effect of the collective ED patient group on the frequency and nature of adverse events for individual ED patients is poorly understood and warrants further investigation.
authors.affiliation: Northern Health, 185 Cooper St, Epping, Victoria 3076, Australia. Electronic address: belinda.scott@nh.org.au.
authors.forename: Belinda Mitchell
authors.initials: BM
authors.lastname: Scott
authors.affiliation: Eastern Health - Deakin University Nursing & Midwifery Research Centre, School of Nursing and Midwifery, Deakin University, Centre for Quality and Patient Safety Research, Australia. Electronic address: julie.considine@deakin.edu.au.
authors.forename: Julie
authors.initials: J
authors.lastname: Considine
authors.affiliation: Epworth Deakin Centre for Clinical Nursing Research, School of Nursing and Midwifery, Deakin University, Centre for Quality and Patient Safety Research, Australia. Electronic address: mari.botti@deakin.edu.au.
authors.forename: Mari
authors.initials: M
authors.lastname: Botti
mesh_terms: D000367:Age Factors; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D016529:Emergency Nursing / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital; D006767:Hospitals, District; D006801:Humans; D011446:Prospective Studies; D012307:Risk Factors; D014218:Triage / Q000706:statistics & numerical data*; D014504:Urban Health; D014739:Victoria / Q000453:epidemiology
keywords: Deteriorating patient; Emergency medicine; Emergency nursing; Patient safety; Rapid response system; Risk management