Excellence in Clinical Practice

Recognising and responding to acute deterioration SJWA project: Introduction of early warning scores and clinical escalation pathways St John WA

Team: Jason Belcher, Rudi Brits, Moin Uddin, Deane Coxall, Lauren Davids, Earl Beech, Marco Madiantoro

In early 2022, St John WA (SJWA) introduced an observation-based Early Warning Score (EWS) and associated clinical escalation pathway into frontline ambulance practice for all clinicians. While the Recognising and Responding to Acute Deterioration (RRAD) project introduced a system that helped bring SJWA into alignment with National Safety and Quality Health Service (NSQHS) Standard 8 (Recognising and Responding to Acute Deterioration), it more importantly was designed to increase patient safety through better identification of patients who have unrecognised critical illness or have high potential to deteriorate. There were identified gaps in recognition of these patients but also with processes to escalate concerns of patients who were unwell or deteriorating – particularly in an Extended Transfer of Care (ramping) environment. This project has introduced a systematic process to help find patients of concern and to escalate concerns, which ultimately saves lives.

The RRAD project is currently in Phase 2, as the clinical guideline for scoring and escalation of concern in adult patients is operational and already delivering positive results, however some supporting technology is being piloted and in development. SJWA believes implementation of technology to automate calculation of a score and increase real-time oversight of patients will increase uptake of SJWA’s RRAD system with all patients to improve patient safety.

Since implementation, SJWA have seen a positive impact on patient safety, with a reduction in reported incidents related to unrecognised deterioration or non-recognition of a high acuity patient. There has also been positive feedback from frontline clinicians who appreciate an objective measure to communicate concerns when escalating care. Hospital staff have indicated the system, which uses commonly understood language, has led to better communication and understanding when concerns are escalated, and SJWA Hospital Liaison Managers (HLMs) have also expressed views that the system has allowed more effective communication and escalation of patients of concern.

This project has potential to be replicated nationally using early warning systems as relevant to each ambulance service and their health system’s jurisdictional context.