Is there a role for patients and their relatives in monitoring, detecting and escalating clinical deterioration in hospital?

Measures exist to improve early recognition of, and response to deteriorating patients in hospital. Yet, 11% of deaths in UK hospitals in 2005 were the result of patient deterioration going unrecognised or not being acted on (NPSA, 2007). The thesis aimed to investigate whether patients and relatives can aid health professionals in recognising clinical deterioration. A systematic review was conducted which identified interventions that allow patients and relatives to escalate patient deterioration. However, there is not strong evidence for the clinical effectiveness of these interventions, and a limited understanding of patient and relative ability to recognise patient deterioration. In study 1, health professionals generated potentially feasible and acceptable methods of involving patients and/or relatives in recognising deterioration in hospital. Recording patients’ views on changes in their wellness during routine observation was proposed. Focus groups were held in study 2 with healthcare assistants and patients to develop a questionnaire to capture patients’ and relatives’ ratings of patient wellness. Study 3 piloted approaches to routinely collecting patient wellness ratings using the questionnaire on in-patient wards. Where the researcher attended observation to record patients’ ratings, this was acceptable to most patients. However, there was limited uptake where patients and relatives were invited to complete the questionnaire themselves, and staff were invited to record patients’ wellness ratings during observation. It may be necessary to encourage and support staff to adopt this change in practice. In study 4, the use of behaviour change techniques to encourage staff to routinely record patient-reported wellness in practice were effective on wards showing high previous levels of engagement with the observation system. The clinical effectiveness of routinely recording patient-reported wellness was also explored. Significant associations between patient-reported wellness, and early warning score and vital sign measurements were found, and these were stronger in more acutely unwell patients. Evidence from the thesis suggests that routinely recording patient-reported wellness may be one feasible strategy that could aid health professionals in the early recognition of clinical deterioration.