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Responding to Clinical Deterioration

Ambulatory Surgery Centers (ASC) offer patients an alternative to having surgery in the hospital setting. This option has reduced wait times for surgery and increased patient satisfaction.

One of the important aspects of being able to provide these services in a safe and effective manner is the early recognition and response to patient complications. During an Accreditation Commission for Health Care (ACHC) Accreditation Survey, the Surveyor will review the organization’s clinical deterioration policy to verify that the policy provides clear guidance on how to respond to these situations.

Standard 07.01.04 requires an organization to develop a policy to identify and respond to patient deterioration. The standard states:

The ASC leadership has a policy approved by the medical staff that
- Describes staff response upon recognition of patients with clinical deterioration.
- Establishes the documentation expectations for the unstable patient including:
  - vital signs,
  - treatments,
  - medications, and
  - patient response to treatments.

The standard also requires that documentation show staff are trained for this type of event.

If the assessment determines the need to transfer the patient to another level of care, contact with the receiving organization must be documented, including the time this contact was made, and all other transport policies must be followed.

Tips for Compliance

Thorough preparation, including training, can help an organization be prepared for an incident of patient deterioration:

Education of staff on early signs and symptoms of a change in condition.
A response plan that everyone understands and is familiar with.
Training of staff in the use of emergency equipment and in cardiopulmonary resuscitation.
Regular testing and maintenance of emergency equipment.
Practice drills with staff.
Clinical deterioration worksheets kept bedside to guide staff during an emergency.
Careful pre-screening of surgical patients.
Thorough preoperative assessment.
Post-event incident reporting.
Post-incident chart reviews with tracking and trending.

Additional Resource

According to an article published by the National Center for Biotechnology Information, one tool a healthcare organization can use to identify early warning signs of clinical deterioration is the Modified Early Warning Score (MEWS). This is a physiological score that may aid in the improvement of early recognition of changes in a patient’s condition and improve quality outcomes of surgical patients.

To calculate the MEWS score, a nurse assigns a number from 0 to 3 to each of the six vital signs. The sum of the assigned numbers determines the patient’s MEWS score. If the total score is 4 or greater, the nurse must notify the patient’s physician.

Modified Early Warning Score

Score	3	2	1	0	1	2	3
Respiratory rate (min−1)		≤ 8		9–14	15-20	21-29	> 29
Heart rate (min−1)		≤ 40	41-50	51-100	101-110	111-129	> 129
Systolic BP (mmHg)	≤ 70	71-80	81-100	101-199		≥ 200
Urine output (ml/kg/h)	Nil	< 0.5
Temperature (°C)		≤ 35	35.1–36	36.1–38	38.1–38.5	≥ 38.6
Neurological				Alert	Reacting to voice	Reacting to pain	Unresponsive

The scores for each parameter are recorded at the time that observations are taken. If the total is 4 or more, then the ward doctor is informed.

Here to Help

If you have questions or need more information, please contact your Account Advisor, email customerservice@achc.org, or call (855) 937-2242.

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How Healthcare Providers Can Get from P's to Q

Policies, procedures, plans, and programs create quality? Barb Sylvester, RN, MSOLQ, describes how an ACHC quality expert makes the connection. She shares her love of policies and her perspective on the purpose of an ACHC survey. (You might be surprised by what she says is most important.) Listen now to Episode 7: Mind the Gap.

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Some content presented in “Did You Know?” may consist of timely or topical articles deemed to be of interest to the provider community. These are presented for informational purposes as a service to our readers. The views, opinions, and positions expressed by the authors are theirs alone and do not necessarily reflect the views, opinions, or positions of ACHC, its related entities, or any employee thereof.