Checklists are no substitute for experience in spotting patients who are deteriorating

Description of impact

Highlighted in NIHR Signal

Who is affected

Nurses

Narrative

Experience was found to count in recognising and acting on patient deterioration. National guidelines recommend the use of “track and trigger” systems to monitor seriously ill patients for the signs of deterioration. Following their identification, prompt referral to critical care teams is suggested, for example, but this does not always happen reliably. This realist review explored the organisational factors within UK hospitals that influence how and why these alert systems work in practice.

Experienced nurses used the protocols effectively, alongside their clinical judgment in knowing when to refer for specialist assessment and to quantify concerns. Standard protocols were found to be useful; however, reluctance to challenge staff hierarchy still prevented junior staff referring directly when they suspected deterioration.

The culture where monitoring tasks are frequently delegated to junior nursing staff was noted. Incomplete or inaccurate observations and lack of experience to judge the importance of clinical signs were also linked with failure to seek a rapid response.

This highlights the need for training including simulation and improved teamwork between healthcare disciplines to empower staff to use track and trigger systems effectively.

Impact status	Completed
Impact date	14 Nov 2017
Category of impact	Health Impact
Impact level	Engagement