@article{ref1,
title="Between the flags: implementing a safety-net system at scale to recognise and manage deteriorating patients in the New South Wales Public Health System",
journal="International journal for quality in health care",
year="2016",
author="Pain, Charles and Green, Malcolm and Duff, Colette and Hyland, Deborah and Pantle, Annette and Fitzpatrick, Kimberley and Hughes, Cliff",
volume="29",
number="1",
pages="130-136",
abstract="QUALITY PROBLEM: In 2005, the Clinical Excellence Commission (CEC) found that unrecognised patient deterioration remained an important problem in New South Wales (NSW) public hospitals. INITIAL ASSESSMENT: The challenge was to design and implement an effective and sustainable safety-net system in all 225 NSW public hospitals. DESIGNING A SOLUTION: The CEC's system was designed in collaboration with a broad coalition of partners, including clinicians, managers, system administrators and collaborating agencies. A five-element system comprising governance, standard calling criteria in standard observation charts, two-level clinical emergency response systems (CERS) in each facility, an education programme and evaluation, was designed for state-wide implementation. This system was called 'Between the Flags' (BTF). IMPLEMENTATION: Implementation was led by the CEC on behalf of a NSW coalition, and commenced in January 2010 with the implementation of the Standard Adult General Observation Chart, awareness training for all staff and a CERS in each facility. EVALUATION: Since the introduction of BTF, the cardiac arrest rate has declined by 42% (P < 0.05) and the Rapid Response rate has increased by 135.9% (P < 0.05) in NSW. The strength of staff support for BTF has grown with the proportion of respondents strongly agreeing that BTF has benefitted patient safety more than doubling from 21% to 44%, and overall agreement rising from 68% to 82% between 2010 and 2012. LESSONS LEARNED: Key success factors are a focus on governance, standardisation of observation charts and striking the right balance between a rule-based approach and individual clinical judgement.<br><br>© The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<p /> <p>Language: en</p>",
language="en",
issn="1353-4505",
doi="10.1093/intqhc/mzw132",
url="http://dx.doi.org/10.1093/intqhc/mzw132"
}