Standard 9: Recognising and Responding to Clinical Deterioration in Acute Health Care

NSQHS Standard 9 supports the provision of appropriate and timely care to patients whose condition is deteriorating. The National Consensus Statement: Essential Elements for Recognising and Responding to Clinical Deterioration was developed by the Commission and has been endorsed by Australian Health Ministers as the national approach for recognising and responding to clinical deterioration in Australia. NSQHS Standard 9 builds on this to drive implementation in acute care health services.
Standard 9 requires acute health services to establish and maintain systems for recognising and responding to clinical deterioration. The intention of the NSQHS Standard 9 is to ensure that a patient’s deterioration is recognised promptly and appropriate action is taken. NSQHS Standard 9 applies to all patients in acute health care including adults, adolescents, children and babies, and to all types of patients including medical, surgical, maternity and mental health patients. Acute health services include larger tertiary referral centres through to small district and community hospitals. NSQHS Standard 9 does not apply to deterioration of a patient’s mental state, although the Commission has recently commenced work focussed on this area.
Data from the first year of accreditation is now available, and it provides information about how acute health services are meeting the requirements of NSQHS Standard 9.
Ratings for actions in NSQHS Standard 9
In 2013, 292 health services were assessed to NSQHS Standard 9. Across all of these services 73% of all actions were met, 14% were not met and 2% were met with merit. For 11% of actions, health services had successfully submitted to their accrediting agency that the action was not applicable to their service. There were differences in the proportion of core and developmental items that were met: 88% of core items were met, compared with 45% of developmental items.
Areas that were most commonly rated as ‘not met’ involved the establishment of systems to allow patients, families and carers to initiate an escalation of care response; and providing information to patients, families and carers about recognition and response systems. These actions are developmental. Of the core actions, the areas that were most commonly rated as ‘not met’ were auditing to ensure that patients have observations recorded in agreement with their monitoring plan, and taking action to improve recording of observations.
Areas that were more likely to be rated as ‘met with merit’ related to having mechanisms in place to escalate care and call for assistance, and auditing these calls, including outcomes for patients and failures to act on triggers for escalation.
Met with merit ratings
When organisations are assessed to the NSQHS Standards the accrediting agencies use a three-point rating scale to assess a service. These ratings are ‘not met’, ‘met’ and ‘met with merit’. Met with merit ratings are awarded when, in addition to achieving the actions required, measures of good quality and a higher level of achievement are evident. There is a culture of safety, evaluation and improvement throughout the organisation in relation to the action or standard under review.
For health services that achieved a met with merit rating, surveyors highlighted that the systems they had in place had many of the following characteristics:

• a patient-centred focus


• change management frameworks to ensure that recognition and response systems were well embedded across the organisation


• strong governance systems


• robust and comprehensive data collection processes, including mechanisms for routinely feeding back data to individual wards and clinical units


• continuous improvement processes


• good education frameworks.

 
change management frameworks to ensure that recognition and response systems were well embedded across the organisation
strong governance systems
robust and comprehensive data collection processes, including mechanisms for routinely feeding back data to individual wards and clinical units
continuous improvement processes
good education frameworks.