Early warning sign system for Scots heart patients

From left to right: Jenny Morrison, Ronnie Dornan, Hazel Prentice and Lisa Hume. Picture: Contributed

Following the success of a team of Critical Care Outreach nurse specialists at Borders General Hospital, other sites around Scotland are implementing their own schemes to improve outcomes for patients.

The system involves closely monitoring patients using blood pressure, heart rate and blood tests to identify early warning signs which are then responded to by the specialist team.

The Melrose hospital has seen the number of calls for medics to attend cardiac arrests among patients in the hospital fall from 465 in 2000 to 48 last year.

The scheme, part of the Scottish Patient Safety Programme, has attracted attention from other countries keen to learn from the results.

It comes as Scottish hospitals continue to work towards a target of a 20 per cent drop in avoidable mortality by the end of 2015.

Specialist nurse Ronnie Dornan, who set up the Critical Care Outreach Service, said as well as the drop in cardiac arrest calls, the system had helped the intensive care unit reduce the time patients spent in hospital, cut out-of-hours admissions and decreased the need for patients to be put on a ventilator.

The hospital also has one of the lowest mortality rates in critical care in the country.

Dornan said the key to their success was recognising quickly when a patient needed extra help and making sure that was provided quickly.

“The important thing is that in a hospital the team recognises as early as possible that someone is showing signs of deterioration, or that they are at risk of deterioration,” he said.

“The earlier you pick that up and intervene and manage it, the better your outcomes will be. If they need critical care, it is about getting them there as quickly as possible.”

The system involves close monitoring of patients for a range of changes in their condition which could signal they need extra help.

Dornan said: “We are monitoring blood results, looking for signs of deterioration in those, organ deterioration, signs of sepsis and infection.

“But at a basic level the nurses on the wards would do a set of vital signs which is heart rate, respiratory rate, blood pressure and temperature. So there is a trigger system, and if the vital signs start to drift out of the normal parameters that will prompt the nurse to give the team a call and we will come to assess and examine the patient and decide what needs to be done.”

While many people would expect this monitoring to be standard in all hospitals, Dornan said the key was making sure staff were ready to respond quickly when required to help a patient.

“They are normally monitored, but it’s about having a reliable system that makes sure everything happens quickly,” he said.

“In a perfect world all that is being monitored, but on a normal day there can be many variables on a busy hospital ward.

“So it’s about that recognition and expediting it and getting that specialist team to come and to assess in more detail.”

The team of four nurses, which has increased since Dornan started the service 12 years ago, are on duty 12 hours a day, seven days a week. But it is possible their work could be extended in future to cover the overnight period.

The team also help educate nurses and medical teams to help recognise and act quickly when patients start to deteriorate.

Dornan said other hospitals had also started using similar systems to improve their own performance.

The Borders scheme has received interest from health teams in the United States and Denmark, most recently featuring on the Danish news after inspiring a visiting consultant impressed by the work being done.

Dr Jens Stubager, a consultant at Kolding Hospital in Denmark, said: “My study visit to Borders General Hospital has been truly inspirational.

“The methods of dealing with the deterioration of patients that Ronnie and his team have developed are quite ground-breaking and evidently provide outstanding results.

“Since appearing on our national news, the methodology has created huge debate around the whole country and politicians are now looking to take patient safety more seriously.”

Margaret Watt, chair of the Scotland Patients’ Association, welcomed the results seen in the Borders and said these should be repeated elsewhere.

“Anything that makes the services better and safer for patients is super,” she said.

“They should roll it out because, let’s face it, Scotland has some of the sickest patients in Britain because of heart problems.”