In patients who are, or become acutely unwell in hospital, there is evidence that deterioration is not always recognised or it is not acted on rapidly enough (NICE, 2007). The Walton Centre NHS Foundation Trust wanted to improve observation recording, recognition and response to deteriorating patients using the NEWS assessment tool.
The Walton Centre is the only specialist hospital trust in the UK dedicated to providing comprehensive neurology, neurosurgery, spinal and pain management services. The Walton Centre established a critical care outreach team (surgical and medical acute response team: SMART) team in December 1999 in response to the Department of Health’s report; Comprehensive Critical Care: A Review of Adult Critical Care Services (May 2000).
This small team consisted of senior nurses with a background in neuro critical care with close links to the anaesthetic and nursing staff from the intensive care unit. In 2015 the team expanded to create a 24 hr / 7 day service to ensure expertise available during weekdays was expanded to cover the hospital at night and the weekends. Wards at the Walton Centre use a Track and Trigger system or Early Warning Score to monitor and assess patients and to detect deterioration in patient well-being. If a patient’s score indicates that they may be deteriorating or nursing staff are concerned, patients will be referred to the SMART. If after review, a higher level of care is required, the patient is transferred to the appropriate area, for more specialised treatment or monitoring.
The Track and Trigger system includes the routine collection of data broken down to ward area for analysis in the following categories:
- Observations undertaken within prescribed frequency for patients currently admitted
- Observations are only included if there is a preceding observation
- Observations without a score (partial) are excluded from the total
In July 2018 it was found that of the 16,382 patients seen, there were almost 1,000 (6%) for whom no observation score was recorded. Only 4 in 10 patients who did receive a score were compliant with standards.
Read the full case study here.