This study examined outcomes of patients who experienced clinical deterioration requiring an emergency response within 24 hours or after 24 hours of emergency admission to medical or surgical wards. The study found that 28.4% of patients experienced deterioration within 24 hours of admission, who had lower rates of recurrent emergency responses, ICU admissions, and shorter hospital lengths of stay, compared to those whose deterioration occurred after 24 hours. Over half of all emergency responses on medical and surgical units during the study period were for patients admitted through the emergency department. Further research is needed to understand factors contributing to early clinical deterioration in patients admitted via the emergency department.

1. Outcomes of patients who require
emergency response for clinical
deterioration within and beyond 24
hours of emergency admission
Julie Considine,1,2,3 Judy Currey,1,2 David Charlesworth41
School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
2 Centre for Quality & Patient Safety Research, Deakin University, Burwood, Victoria, Australia
3 Eastern Health – Deakin University Nursing & Midwifery Research Centre, Box Hill, Victoria, Australia
4 Intensive Care Services, Eastern Health, Box Hill, Victoria, Australia

2. Background
Access targets
• many countries, including Australia, have set ED LOS
targets as a quality indicator of healthcare
• Australia = NEAT in 2011
• National Emergency Access Target = 90% of patients have
ED LOS <4 hours
Concerns
• will shorter ED LOS result in
• increased numbers of physiologically unstable patients on
medical / surgical wards?
• increased incidence of clinical deterioration during the
early stages of hospital admission?

3. Aim
• to compare the characteristics & outcomes of
patients who required an emergency response for
clinical deterioration* < 24 hours and ≥ 24 hours of
emergency admission to medical and surgical units
* emergency response for clinical deterioration = cardiac arrest team or rapid
response system activation

4. Method
Design
• a retrospective medical record audit
Site
• Box Hill Hospital, Eastern Health
• 365 bed urban district hospital in Melbourne, Australia
• 46,640 ED presentations (2011/12)
• 17,343 adult patients (≥ 18 years) requiring medical &
surgical admission via ED (2011/12)
• RRS = MET since early 2012
• 9 medical or surgical wards (~214 beds)

5. Method
Sample
• adult patients (≥ 18 years)
• admitted to a medical or surgical ward via the ED
• who required an emergency response for clinical
deterioration during 2012
• exclusions: patients in whom emergency response
was located
• birthing suite / maternity wards
• inpatient mental health
• critical care unit

6. Results
819 patients on medical / surgical wards = 1480 emergency responses
81.3% MET activations
(n=1203 responses)
18.7% cardiac arrest team activations
(n=277 responses)
71% of patients (n=587) admitted via ED = 819 emergency responses
91.0% MET activations
(n = 534 patients)
9.0% cardiac arrest team activations
(n = 53 patients)
28.4% of patients had emergency
response <24 hours after admission
(n = 167 patients)
71.6% of patients had emergency
response ≥24 hours after admission
(n = 416 patients)
* 4 patients lost to follow-up

7. Results
Patients admitted via ED
• 819 emergency responses in 587 patients admitted
via ED
• 55.3% of all emergency responses during 2012 were for
patients admitted via ED
• median time to 1st emergency response was 59
hours (IQR = 22 – 132.6)

8. Results
0%
20%
40%
60%
80%
100%
Triage ATS 1* Stayed on
ward
CCU ICU* In-hospital
mortality
Recurrent
MET
activations*
1st emergency response <24 hours 1st emergency response ≥ 24 hours
(*p <0.05)

9. Results
0 2 4 6 8 10 12
Hospital LOS*
ED LOS
1st emergency response <24 hours 1st emergency response ≥24 hours
(*p <0.05)
(hours – Mdn)
(days – Mdn)

10. Conclusions
• ½ of all emergency responses for deterioration on
medical / surgical units were for patients admitted via
ED
• emergency responses for deterioration with 24 hours
of emergency admission
• occurred in 1/
3 of patients
• were associated with
• less recurrent activations
• lower ICU admission rates
• shorter hospital LOS
• further research is needed to understand antecedents
to deterioration in patients admitted via ED

11. julie.considine@deakin.edu.au
Considine J, Charlesworth D, Currey J. (in press). Characteristics and outcomes
of patients requiring rapid response system activation within 24 hours of
emergency admission. Critical Care and Resuscitation. accepted 6/5/2014.