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

Required reading for all learners: Implicit Bias impacts patient outcomes

Despite efforts to improve early detection of deterioration in patients’ condition, a large proportion of hospitalized patients continue to experience delays in intervention, which can lead to serious adverse events such as unplanned intensive care unit (ICU) admission or death. Up to 80% of serious adverse events are preceded by clinical signs of instability 24 hours or more before the event. In addition to monitoring of vital signs, early indicators of deterioration can be identified through physical assessment and purposeful and frequent surveillance of patients. 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 having nurses performing systems-based physical assessments. A retrospective observational cohort design was used to evaluate all patients who had a rapid response team activation during the study period. 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.