Between the flags: implementing a safety-net system at scale to recognise and manage deteriorating patients in the New South Wales public health system

Charles Pain, Malcolm Green*, Colette Duff, Deborah Hyland, Annette Pantle, Kimberley Fitzpatrick, Cliff Hughes

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

13 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)130-136
Number of pages7
JournalInternational Journal for Quality in Health Care
Volume29
Issue number1
DOIs
Publication statusPublished - 1 Feb 2017
Externally publishedYes

Keywords

  • quality improvement < quality management
  • quality culture < quality management
  • health policy < healthcare system
  • adverse events < patient safety
  • hospital care < setting of care

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