Frequently Asked Questions

Recognition and Management of patients who are deteriorating Policy changes

Mental state

Q: Has there been any more direction on assessment of mental state deterioration?

  • A: Deteriorating mental state is something relatively new to focus on from version 2 of the National Standards and the policy development group agreed that confusion/change in behaviour was the best place to start. This includes an assessment of the patient's behaviour in the context of their developmental age and/or baseline assessment, noting changes in their cognitive function, activity/tone, perception, or emotional state such as abnormal thinking, irritability, agitation, inconsolability and/or delirium.
  • In the adult eMR charts we've added 'C' (new confusion or change in behaviour) to the AVPU scale to make a ACVPU scale, this has been used in the NHS National Early Warning Score (NEWS 2) for the past few years. This feature is available in V4 of the BTF charts in the eMR. You can find more information including videos here.


Q: What are the time frames for the acute and chronic altered calling criteria settings?

  • A: Chronic calling criteria are set to stay in place for the entire patient encounter. Acute changes to calling criteria can be set for 1 to 8 hours when they will then revert to the standard settings.

Q: What is the maximum time for acute altered calling criteria?

  • A: The maximum time is 8 hours and the calling criteria will then revert to normal BTF parameters.

Q: Will the paper charts be altered to include acute and chronic alternations and if so when will they come out?

  • A: Yes, this will go through the normal state forms processes and the CEC will advise when these become available.

Q: Will there be a dedicated education package around acute and chronic calling criteria and an update of the DETECT education?

  • A: eHealth NSW have developed eLearning modules to support implementation. Please refer your teams to My Health Learning portal and search for eMR:Between the Flags course code 131316408. There is a specific alteration to calling criteria section which takes less than 10min to complete.

Q: Does the chronic altered calling criteria have a forcing function for review at 72 hours?

  • A: A chronic alteration may be set for the duration of the patient's episode of care and needs to be formally reviewed by the clinical team responsible for the patient's care during routine assessments. A chronic alteration may be set for patients treated in non-hospital or residential care settings and a review period must be set at the time the alteration is ordered and documented in the patient's medical record. This review period setting (maximum 72 hours) in the eMR does not 'reset' the alterations to calling criteria thresholds rather is a prompt for clinical staff (medical or nursing) to review the patient. This review period has not changed with the new policy or Version 4 of the new electronic charts.


Q: Are there any plans for eMR/BTF reports to be exported into QIDS?

  • A: Yes there are plans to incorporate the BTF and sepsis reports into QIDS in the future.

Q: Will a report be built into eMR for altered acute and chronic calling criteria?

  • A: A suite of reports have been built to support Version 4 of the electronic charts, including alterations to calling criteria, please see your local eMR team for details.

Q: What is the timeline for reports for the updated Clinical Review and Rapid Response forms?

  • A: The updated Clinical Review and Rapid Response forms were built some time ago and eHealth NSW is asking for sites to test the reports.


Q: Will CEC develop a resource/brochure that can be used to inform/engage families in understanding why/how we use BTF charts?

  • A: An information brochure for patients and families is available to order via Stream Solutions vNH700228 Between the Flags - Keeping Patients Safe - Information for Patients, Families and Carers. July 2016


Q: What further changes will occur in eMR? Is that an LHD decision?

  • A: Version 5 of the electronic BTF charts is currently undergoing scoping requirements with CEC, eHealth NSW and Cerner. Please send any suggestions for change through your Director of Clinical Governance (DCG).

Q: Pain assessment is an issue currently being explored to make improvements. Is it possible to link the pain score to the proposed pain assessment tool?

  • A: CEC to obtain further information to understand the issue from Dot Hughes in SNSW LHD.

General BTF FAQs

Q 1: We are external to NSW Health. Are we able to use the BTF charts in our facility/health area?

  • A 1: Yes, Facilities external to NSW Health are able to use the BTF charts after requesting permission from the Clinical Excellence Commission CE.

Q 2: How do I get permission for my organisation to use the BTF charts?

  • A 2: Your facility/health area chief executive or delegate needs to write to the CEC CE requesting permission to use the charts within your facility. The CEC will then be required to sign a letter of agreement which outlines the terms of use.

Q 3: Can we customise the BTF charts for our own facility?

  • A3: Once a signed letter of agreement is received by the CEC, you can contact the printer regarding the charts. Modifications that can be made include substituting the NSW Health logo with your facility logo, with the following words beneath "Used with permission of the Clinical Excellence Commission".

Q 4: When will the charts be available on eMR (electronic medical records)?

  • A 4: The NSW Standard Observation Charts for Adults and Paediatric (Standard and Emergency Department versions) are available electronically through the CERNER eMR. The design has been shared with NSW LHDs using non-CERNER eMR. Emergency Departments were the first to start using the electronic charts and implementation continues throughout hospitals across the state. Contact the eMR State Baseline Build (SBB) team at eHealth NSW for further information.

Q 5: Are all staff (clinical and non-clinical) required to complete BTF education?

  • A 5: Yes, education varies depending on your role within the organisation. Please discuss with your unit manager and/or your facility delegate responsible for BTF and DETECT training.

Q 6: Who do I contact regarding BTF issues within my facility?

  • A 6: Each facility and LHD has delegated executive sponsors and program managers for Between the Flags who can be contacted regarding any feedback.