Track, trigger and teamwork: Communication of deterioration in acute medical and surgical wards

Summary 

Background

The majority of hospitals in the United Kingdom (UK) use some form of track and trigger scoring system, such as early warning scores, to identify deteriorating patients; however, response by the multi-professional team is not always timely and problems with recognition of deterioration persist.

Aim

To examine ward nurse and critical care outreach staff perceptions of the management of patients who deteriorate in acute wards.

Methods

A qualitative design was used with critical incident (CI) technique employed to structure data collection. Semi-structured interviews were undertaken with nurses who had managed a patient who was referred to the outreach team (n=11) and members of the outreach team (n=3).

Results

Registered nurses in this study looked at trends when assessing their patients visually. However, early warning scoring was not a key component of patient assessment and was used more commonly to quantify deterioration once the patient's changing condition had been recognised. Findings demonstrated some tensions in team communication.

Conclusions

The results of this study suggest that clinicians need a better understanding of the value of track and trigger scoring systems in identifying trends in the patient's condition. Further, our data suggest that steps need to be taken in acute hospital wards to improve team members’ understanding of each others’ roles and capabilities.

Keywords: Early warning scoring, Teamwork, Acutely ill patients, Medical and surgical wards