Standard Calling Criteria
Calling criteria for early recognition of the deteriorating patient was standardised across NSW through extensive widespread consultation with clinical experts. Information obtained from current research, together with the application of "human factor" principles provided the basis for the Yellow Zone (Clinical Review) and Red Zone (Rapid Response) criteria and the overall design of the charts. The red and yellow zone criteria are used as a trigger to activate the facility's Clinical Emergency Response System (CERS), which mobilises clinicians to assess, treat and review patients who are deteriorating, or are at risk of doing so.
An essential element of BTF is the incorporation of the calling criteria into the NSW Health Standard Observation Charts. The charts are "track-and-trigger" tools, colour-coded with the Clinical Review (Yellow Zone) and Rapid Response (Red Zone) calling criteria.
The track-and-trigger tool refers to an observation chart that enables vital sign observations to be graphically recorded, with trigger zones clearly identified. The NSW Health Standard Observation Charts allow trends in observations to be tracked, with the visual threshold identified in colour, to trigger a response by the health professional to a breach in the threshold (criteria), when the observation is taken and recorded.
The key features incorporated into the NSW Health Standard Observation Charts include:
- The most sensitive indicator of deterioration is represented on the chart. Respiratory rate, SpO2, oxygen requirement, pulse, blood pressure and neurological assessment are therefore included
- No overlapping of observations, to reduce confusion when recording or interpreting vital signs
- Observation are displayed graphically so that trends can be monitored (tracking)
- Where possible, during the transfer of care from one department to another, the observation charts are continued and therefore maintain the tracking
- Trigger zones are colour-coded to draw attention to when calling criteria are met (at the time of recording or on review)
- Flexibility for variation to standard calling criteria for individual patient, as deemed clinical appropriate. Please refer to NSW Health policy Recognition and Management of Patients who are Clinical Deteriorating (link to policy) and local guidelines
- Number of charts is minimised, by combining the BTF standard observations with the more commonly recorded general observations in a single chart
- The calling criteria are clearly displayed and easily accessible
- Space allocated for recording of blood glucose level (BGL). One-off BGL check does not require a separate form, particularly if it is part of the assessment of a deteriorating patient
- The ability of the chart to identify deterioration depends on the reliability and completeness of the observations
- A Clinical Review or Rapid Response call can also be initiated under the 'serious concern by any staff member' criterion. For example, if a deteriorating trend in clinical observations is detected, even if the patient is not yet in a coloured zone, a clinician may initiate either a Clinical Review or Rapid Response
- All additional Clinical Review and Rapid Response criteria not displayed within the graphed areas are listed within a yellow or red box.
A range of specific charts has been developed to incorporate modifications that reflect needs of specific patient groups. All are being progressively duplicated within the electronic medical records (eMR). In sites that already utilise eMR for observations, the paper-based forms should be utilised in procedures during downtime.