ArticleIntensive & critical care nursing2025
A retrospective records review comparing the care of patients who either avoided or were admitted to an ICU following a ward-based deterioration event.
Article in Intensive & critical care nursing, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo identify escalation success factors documented in care records of patients who triggered an Early Warning Score ≥ 7 in the ward, avoided an Intensive Care Unit admission and survived and compare these with ward patients who triggered an Early Warning Score ≥ 7, went to intensive care and died during their admission.
methodsA multi-site, retrospective records review was conducted on 340 survivors and 50 non-survivors who were either admitted to, or who avoided intensive care.
resultsNon-survivors of deterioration tended to be older, earlier into their hospital admission, and had a greater number of co-morbidities at the time of their trigger event. Overall, superior care was observed in non-survivors when triangulating quality of care scores and escalation care quality metrics (escalation compliance, hourly observations, and medical re-evaluation). Survivors avoided an Intensive Care Unit admission through responding to ward management or being referred to a specialist team. However, 9.7 % (33/340) of survivors were still triggering at the time of discharge, and 54 % of these had either Covid-19 or a long-term cardiorespiratory condition.
conclusionsThis study found differences in how clinical staff responded to patient deterioration between survivors and non-survivors. Although non-survivors received higher-rated care and met more escalation quality indicators, their poorer outcomes were likely influenced by more severe underlying conditions. Despite both patient groups having comparable scores, staff appeared to make nuanced judgments factoring in clinical concerns not captured by the score alone (success factor). IMPLICATIONS FOR CLINICAL PRACTICE: Despite generating the same warning score values, there is wide variation in true patient acuity that only clinical staff can discriminate, and escalation protocols alone may not be advanced enough to address this subtlety.
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