Essay on Response And Treatment Of Deteriorating Patients

Essay on Response And Treatment Of Deteriorating Patients

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Recognition, response and treatment of deteriorating patients are essential elements of improving patient outcomes and reducing unanticipated inpatient hospital deaths (Fuhrmann et al 2009; Mitchell et al 2010) appropriate management of the deteriorating patient is often insufficient when not managed in a timely fashion (Fuhrmann et al 2009; Naeem et al 2005; Goldhill 2001). Detection of these clinical changes, coupled with early accurate intervention may avoid adverse outcomes, including cardiac arrest and deaths (Subbe et al. 2003).

One of such early interventions may be offered by Roper, Logan, Tierney (1980) called the activities of daily living model. As explained in the presentation, the model consists of an individual’s ability to carry out self-care tasks such as functional mobility, self-feeding, personal hygiene and grooming (Roper, Logan & Tierney, 1980). Thus, any change in these may be considered as a deteriorating patient.

However, this approach not only lacks objectivity, but it also fails to acknowledge the abnormal physiology that precedes this breakdown in self-care. For instance, it has been reported that 70% of patients preceding cardio-pulmonary arrest had a physiological decline in respiratory or mental function (Schein et al 1990). Observing deterioration in activities of daily living alone does not accurately mirror underlying physiological deterioration occurring in patients.

On account of theses limits other tools that are more efficient, objective and accurate are necessary to enhance acute hospital care. The National Institute for Health and Clinical Excellence (NICE 2007) have highlighted the importance of a systemic approach and advocated the use of EWS to efficiently identify and response to pa...


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...ways the case as many studies have failed to validate these systems, some revealing poor sensitivity, poor positive predictive value and low reproducibility (Gao et al 2007; Smith et al 2008; Subbe et al 2007; Jansen et al 2010).

Considering the conflicting findings amongst the different EWS, it remains unknown whether these scoring systems are effective in identifying and responding to deteriorating patient in acute hospital settings. This essay intends to establish how successful, if at all, the EWS in particular SHEWS is in identifying deteriorating patients in acute surgical hospital settings. In order to do this we will be returning to patient X, a 22-year-old Asian female with a diagnosis of acute pancreatitis. By comparing the evidence base to reality I hope to get a better understanding of how effective this tool is in identifying deteriorating patients.

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