Trinity College Dublin, The University of Dublin

Can implementation of an Emergency Department monitoring and escalation protocol for adult patients reduce the number of critical incidents and improve timely intervention in patients requiring a higher level of care and improve clinical outcomes?

Approximately 1.1 million people attend EDs in Ireland each year. Minimising clinical risk in this large patient population is the essence of the specialty of Emergency Medicine. The Report by the Health Information and Quality Authority (HIQA), May 2012, of the investigation into the quality, safety and governance of the care provided by the Adelaide and Meath Hospital, Dublin, incorporating the National Children’s Hospital (AMNCH) for patients who require acute admission, recommended that “an Emergency Department-specific system of physiological monitoring and triggered responses comparable to the National Early Warning Score (NEWS) should be implemented”. An ED Monitoring and Clinical Escalation Protocol compatible with the NEWS has therefore been designed by the National Emergency Medicine Programme (EMP) to meet the HIQA requirement for adult patients in ED. The objective of this research is to assess the impact of this Protocol - developed to reduce clinical risk through timely assessment and escalation – on the performance of Cork University Hospital (CUH) ED. The project aims to minimise clinical risk through timely reassessment and appropriate clinical escalation (for example, transfer to a high dependency unit) for patients who are waiting in the ED to be seen by ED medical teams and hospital in-patient on-call teams. The Protocol provides a structured approach that formalises and standardises this process nationally and enables the integration with other patient monitoring and Early Warning Score methodologies.