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

Author(s): Shannan K. Hamlin, PhD, RN, ACNP-BC, AGACNP-BC, CCRN, NE-BC, Nicole M. Fontenot, DNP, APRN, ACNP-BC, CCNS, CCRN-K, Steven J. Hooker, MSN, RN, CCNS, NE-BC, Adriana L. Ordonez, PhD, and Hsin-Mei Chen, PhD, MBA

Contact Hours 1.00

CERP C 1.00

Expires Sep 01, 2026

Topics: Quality Improvement

Member: Free
NonMember: $10.00

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Activity Summary

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.


  • Describe the value in nurses' performing a systems-based physical assessment early in their shift to reduce the risk of adverse events.
  • Describe why early recognition and intervention in patient clinical deterioration is important.
  • Describe why relying on abnormal vital signs alone might delay early recognition and intervention in patient clinical deterioration.

Continuing Education Disclosure Statement

Successful Completion

Learners must attend/view/read the entire activity, read Implicit Bias impacts patient outcomes, and complete the associated evaluation to be awarded the contact hours or CERP. No partial credit will be awarded.


The American Association of Critical-Care Nurses is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation.

Provider approved by the California Board of Registered Nursing, Provider number CEP 1036, for 1.00 contact hours.

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