title: Managing serious clinical deterioration in a tertiary hospital in Hong Kong: from indicators development to multiple measures in reducing the rates.
abstract: OBJECTIVE
  Timely detection and management of acutely deteriorating patients can save lives. Tuen Mun Hospital (TMH), a 1800-bed acute tertiary hospital serving more than 1.06 million populations in Hong Kong, is exploring to quantitatively monitor serious clinical deterioration (SCD) and uses it to guide patient care improvement initiatives.
  
  
  METHODS
  Literature review on definition and measurement of SCD was conducted. Monthly SCD rates of TMH were first calculated according to the published methodology and benchmarked against those of international centres. A refined composite clinical indicator good for local use was compiled. In the second phase, p-control charts of SCD have been plotted based on cumulative data.
  
  
  RESULTS
  TMH's performance was comparable with that of international centres. SCD on p-control charts has been plotting since January 2013. There were peaks in all 4 SCD rates during the winter surge period in 2013-2014. In the third phase, multiple measures have been taking to reduce the SCD rates including targeting the 3 main factors of winter surge situation. We are delighted to observe that the pattern did not repeat in the rate of cardiac arrest without do not attempt cardiopulmonary resuscitation (DNACPR) and rate of death without DNACPR in the same period in 2014-2015.
  
  
  CONCLUSIONS
  SCD becomes a clinical governance tool to monitor the performance of clinical teams in treating acutely deteriorating patients in TMH. Any abnormal patterns or indications of special cause variations in the control charts would alert leaders to look for root causes of special cause variations and manage accordingly. We hope that this project will extend to corporate level and become a sustainable clinical indicator to guide audits, quality improvement initiatives and strategic planning.
authors.affiliation: Quality and Safety Division of New Territories West Cluster, Hospital Authority, Hong Kong.|Department of Anaesthesia and Intensive Care of New Territories West Cluster, Hospital Authority, Hong Kong.
authors.forename: Jasperine Ka Yee
authors.initials: JKY
authors.lastname: Ho
authors.affiliation: Quality and Safety Division of New Territories West Cluster, Hospital Authority, Hong Kong.
authors.forename: Quinnie
authors.initials: Q
authors.lastname: Lee
authors.affiliation: Quality and Safety Division of New Territories West Cluster, Hospital Authority, Hong Kong.
authors.forename: Jaden Chun Ho
authors.initials: JCH
authors.lastname: Lam
authors.affiliation: Quality and Safety Division of New Territories West Cluster, Hospital Authority, Hong Kong.|Department of Anaesthesia and Intensive Care of New Territories West Cluster, Hospital Authority, Hong Kong.
authors.forename: Kam Shing
authors.initials: KS
authors.lastname: Tang
mesh_terms: D019985:Benchmarking; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data; D000075902:Clinical Deterioration; D005260:Female; D006305:Health Status Indicators; D006323:Heart Arrest / Q000453:epidemiology; D006723:Hong Kong; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D016414:Resuscitation Orders; D012621:Seasons; D062606:Tertiary Care Centers / Q000458:organization & administration* / Q000592:standards
keywords: benchmarking; clinical governance; patient care