TY - JOUR
T1 - Between the flags
T2 - implementing a safety-net system at scale to recognise and manage deteriorating patients in the New South Wales public health system
AU - Pain, Charles
AU - Green, Malcolm
AU - Duff, Colette
AU - Hyland, Deborah
AU - Pantle, Annette
AU - Fitzpatrick, Kimberley
AU - Hughes, Cliff
PY - 2017/2/1
Y1 - 2017/2/1
N2 - Quality problem: In 2005, the Clinical Excellence Commission (CEC) found that unrecognised patient deterioration remained an important problem in New South Wales (NSW) public hospitals. Initial assessment: The challenge was to design and implement an effective and sustainable safety-net system in all 225 NSW public hospitals. Designing a solution: The CEC's system was designed in collaboration with a broad coalition of partners, including clinicians, managers, system administrators and collaborating agencies. A five-element system comprising governance, standard calling criteria in standard observation charts, two-level clinical emergency response systems (CERS) in each facility, an education programme and evaluation, was designed for state-wide implementation. This system was called 'Between the Flags' (BTF). Implementation: Implementation was led by the CEC on behalf of a NSW coalition, and commenced in January 2010 with the implementation of the Standard Adult General Observation Chart, awareness training for all staff and a CERS in each facility. Evaluation: Since the introduction of BTF, the cardiac arrest rate has declined by 42% (P < 0.05) and the Rapid Response rate has increased by 135.9% (P < 0.05) in NSW. The strength of staff support for BTF has grown with the proportion of respondents strongly agreeing that BTF has benefitted patient safety more than doubling from 21% to 44%, and overall agreement rising from 68% to 82% between 2010 and 2012.
AB - Quality problem: In 2005, the Clinical Excellence Commission (CEC) found that unrecognised patient deterioration remained an important problem in New South Wales (NSW) public hospitals. Initial assessment: The challenge was to design and implement an effective and sustainable safety-net system in all 225 NSW public hospitals. Designing a solution: The CEC's system was designed in collaboration with a broad coalition of partners, including clinicians, managers, system administrators and collaborating agencies. A five-element system comprising governance, standard calling criteria in standard observation charts, two-level clinical emergency response systems (CERS) in each facility, an education programme and evaluation, was designed for state-wide implementation. This system was called 'Between the Flags' (BTF). Implementation: Implementation was led by the CEC on behalf of a NSW coalition, and commenced in January 2010 with the implementation of the Standard Adult General Observation Chart, awareness training for all staff and a CERS in each facility. Evaluation: Since the introduction of BTF, the cardiac arrest rate has declined by 42% (P < 0.05) and the Rapid Response rate has increased by 135.9% (P < 0.05) in NSW. The strength of staff support for BTF has grown with the proportion of respondents strongly agreeing that BTF has benefitted patient safety more than doubling from 21% to 44%, and overall agreement rising from 68% to 82% between 2010 and 2012.
KW - quality improvement < quality management
KW - quality culture < quality management
KW - health policy < healthcare system
KW - adverse events < patient safety
KW - hospital care < setting of care
UR - http://www.scopus.com/inward/record.url?scp=85017269474&partnerID=8YFLogxK
U2 - 10.1093/intqhc/mzw132
DO - 10.1093/intqhc/mzw132
M3 - Article
C2 - 27920243
AN - SCOPUS:85017269474
SN - 1353-4505
VL - 29
SP - 130
EP - 136
JO - International Journal for Quality in Health Care
JF - International Journal for Quality in Health Care
IS - 1
ER -