Systems-Based Physical Assessments: Earlier Detection of Clinical Deterioration and Reduced Mortality

Abstract

Background Despite efforts to improve early detection of deterioration in a patient’s condition, delays in activating the rapid response team remain common. Objectives To evaluate delays in activating the rapid response team and the occurrence of serious adverse events before and after implementation of a quality improvement initiative aimed at nurses’ performing systems-based physical assessments. Methods A retrospective observational cohort design was used to evaluate all patients who had a rapid response team activation during the study period. Results A total of 1080 patients were included in the analysis: 536 patients before the quality improvement initiative and 544 patients after the quality improvement initiative. The delay in activating the rapid response team decreased from 11.7 hours in the before group to 9.6 hours in the after group (P < .001). In the after group, fewer patients were transferred to the intensive care unit (36% vs 41%, P = .02) and those who were transferred had 3.58 times greater odds of death than those who stayed at the same level of care. The after group had a 44% reduction in the odds of mortality compared with the before group. Conclusions When nurses focus on conducting a systems-based physical assessment early in their shift, delays in recognizing a patient’s deteriorating condition are reduced, fewer patients are admitted to the intensive care unit, and mortality is significantly reduced.