In the past few weeks, a hospital patient safety system that normally operates in the background has come to the forefront of public debate.
The focus of this scrutiny is the paediatric early warning system that detects signs of deterioration during a child's injury or illness at Canberra Hospital.
In my role as Canberra Health Services director of resuscitation I interact with the paediatric early warning system every day. I work with a fabulous group of committed and expert clinicians - the medical emergency team - whose job it is to respond to deteriorating patients, educate staff about patient deterioration and collect and analyse huge amounts of data. I've become concerned that due to this public debate, patients and their families may not have confidence that the system is the best available option to keep them safe.
So what is an early warning system? In essence, it uses clinical observations - such as blood pressure and heart rate - to track a patient's progress. In most, but not all cases, when a patient gets sicker these observations will gradually worsen, even before the patient might feel it themselves.
There are two main types of early warning system: single trigger (where only one observation triggers a response) and scoring systems (where multiple different observations are combined to decide the response).
The early warning system at CHS is a great example of a system-wide process based around best practice.
It began in the mid-2000s as part of ongoing system improvements. For a sophisticated healthcare system such as ours to strive for excellence, small improvements need to be continuously made - a bit like the elite sportspeople who strive for that extra 1 per cent.
To help plan the optimal system, an international review of scientific literature was conducted and a huge amount of data was collected.
The team ended up deciding on a scoring system used at one of the world's biggest and best paediatric hospitals, Great Ormond Street Hospital in London.
After consulting widely, we improved that model by adding in a single trigger as an extra layer of safety. CHS staff helped write the national guidelines around patient deterioration.
The unique education package developed at CHS to support the early warning system is used in many different countries, including across all hospitals in Ireland.
The early warning system has been continuously reviewed and updated for both children and adults since its inception. The most recent large international reviews of early warning systems suggest that our system is at least equivalent, but likely safer than, alternative models. The reviews confirmed that what matters most is consistency in use across a health system.
In health care, tradition previously dictated that senior clinicians' views were accepted by those junior to them. This so-called eminence-based medicine has slowly and rightly given way to evidence-based medicine, where best practice decisions are made based on a review of the best available science and with respect to all team members' opinions.
Early warning systems are an example of the importance of this cultural shift, as they rely on more junior staff to notify more senior staff of their concerns. Our early warning system has embraced this ethos.
Nursing staff can request assistance through the system at any time - even if there are no changes in observations. We introduced a patient and carer activated system called CARE (Call And Respond Early) where you as a consumer can call for help on a dedicated line if you are worried about yourself or a relative.
With a huge new critical services building in the works and a change to a fully digital health record system, our team continue working to make CHS facilities safer places for the members of our community who need us. I hope you can be reassured that not only have we got a safe and effective system now, but that we are constantly working to make it one of the best in the world.
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