Mr Jason Belcher1, Mr Earl Beech1, Mr Rudi Brits1
1St John WA, Belmont, Australia
Situation: Following a high-profile case of non-recognised sepsis at a West Australian Emergency Department in 2021, St John WA (SJWA) identified its own gaps in recognition and processes to escalate concerns over patients with unrecognised critical illness or high potential to deteriorate – particularly when ramped. SJWA had a rise in clinical incident notifications about patients who became very ill because early warning signs were not recognised or attempts to escalate concerns within an ED were unsuccessful.
Task: Bring SJWA into alignment with National Safety and Quality Health Service Standard 8 (Recognising and Responding to Acute Deterioration) and future proof escalation of care between SJWA and WA hospitals, which each have their own individual systems, and update Clinical Guidelines for sepsis recognition.
Action: In early 2022, SJWA introduced an observation-based Early Warning Score system based on the National Early Warning Score 2 (NEWS2) used in the United Kingdom to better recognise patients at risk of physiological deterioration. The RRAD project, in consultation with hospitals, also developed quick reference charts using traffic light colours to indicate patient levels and how to escalate care at each ED.
Result: The RRAD project implements a systematic process which finds and escalates patients of concern -ultimately saving lives. Since implementation, SJWA has seen a 64% reduction in reported incidents of unrecognised deterioration or non-recognition of a high acuity patient, with positive feedback from frontline clinicians, Hospital Liaison Managers and hospital staff about the structured approach and consistent language, indicating a significant improvement in patient safety.
Biography:
Jason Belcher is a paramedic and Clinical Quality Manager at St John WA after completing a higher degree research program in paramedicine at Curtin University. He is passionate about developing systems to improve pre-hospital clinical care, patient safety, and outcomes for patients across the spectrum of acuity.