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Title: Between the flags: implementing a safety-net system at scale to recognise and manage deteriorating patients in the New South Wales Public Health System.
Authors: Pain, Charles
Green, Malcolm
Duff, Colette
Hyland, Deborah
Pantle, Annette
Fitzpatrick, Kimberley
Hughes, Cliff
Affiliation: Top End Health Service, Department of Health, Rocklands Drive, Tiwi 0810, Northern Territory..
Systems Improvement, Clinical Excellence Commission, Level 17 McKell Building, 2-24 Rawson Place Sydney 2000, NSW, Australia..
Clinical Governance, South Western Sydney Local Health District, Liverpool Hospital, Corner of Elizabeth and Goulburn Streets, Liverpool NSW 2170, Australia..
Strategic Relations and Communications, NSW Ministry of Health, 73 Miller Street North Sydney, NSW 2059, Australia..
Patient Safety, Tasmania Department of Health, Tasmanian Health Service, Tasmania, Level 1, Northern Integrated Care Service, 41 Frankland Street Launceston 7250, Tasmania, Australia..
Service Development, South Eastern Sydney Local Health District, The Sutherland Hospital, Corner The Kingsway & Kareena Road, Caringbah NSW 2229, Australia..
Clinical Excellence Commission, Level 17 McKell Building, 2-24 Rawson Place, Sydney 2000, NSW, Australia..
Issue Date: 1-Feb-2017
Citation: International journal for quality in health care : journal of the International Society for Quality in Health Care 2017-02-01; 29(1): 130-136
Abstract: In 2005, the Clinical Excellence Commission (CEC) found that unrecognised patient deterioration remained an important problem in New South Wales (NSW) public hospitals. The challenge was to design and implement an effective and sustainable safety-net system in all 225 NSW public hospitals. The CEC's system was designed in collaboration with a broad coalition of partners, including clinicians, managers, system administrators and collaborating agencies. A five-element system comprising governance, standard calling criteria in standard observation charts, two-level clinical emergency response systems (CERS) in each facility, an education programme and evaluation, was designed for state-wide implementation. This system was called 'Between the Flags' (BTF). Implementation was led by the CEC on behalf of a NSW coalition, and commenced in January 2010 with the implementation of the Standard Adult General Observation Chart, awareness training for all staff and a CERS in each facility. Since the introduction of BTF, the cardiac arrest rate has declined by 42% (P < 0.05) and the Rapid Response rate has increased by 135.9% (P < 0.05) in NSW. The strength of staff support for BTF has grown with the proportion of respondents strongly agreeing that BTF has benefitted patient safety more than doubling from 21% to 44%, and overall agreement rising from 68% to 82% between 2010 and 2012. Key success factors are a focus on governance, standardisation of observation charts and striking the right balance between a rule-based approach and individual clinical judgement.
DOI: 10.1093/intqhc/mzw132
Type: Journal Article
Subjects: adverse events < patient safety
health policy < healthcare system
hospital care < setting of care
quality culture < quality management
quality improvement < quality management
Heart Arrest
Hospital Rapid Response Team
Hospitals, Public
Medical Records
New South Wales
Patient Safety
Program Development
Program Evaluation
Disease Progression
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