The prevalence of recordings of the signs of critical conditions and emergency responses in hospital wards - The SOCCER study

Objective: To estimate the prevalence of recordings in case notes of disturbed physiological variables in adult admissions in general hospital wards. Design and setting: Retrospective cross-sectional survey of 3160 admissions in general wards in five hospitals in a 14-day period. Main outcome measures: Recordings of 26 potential early signs (ES) and 21 potential late signs (LS) of critical conditions. Eight late signs were classified as Liverpool Hospital Equivalent Calling Signs (LES). Results: 54.7% admissions had at least one recording of early signs, 16.0% late signs and 6.4% LES. When ranked in order of recordings per 100 admissions, the top five ES were SpO(2) 90-95% (193.7), systolic blood pressure (SBP) 80-100 mmHg (85.2), pulse rate 40-49 or 121-140 b/min (32.0), SBP 181-240 mmHg (23.0) and Other (22.1) (mainly breathlessness or temperature > 38 degrees C). The top five LS were SpO(2) < 90% (31.5), pulse rate < 40 or > 140/min (6.6), SBP < 80 mmHg (4.2), GCS <= 8 (3.8) and unresponsiveness to verbal commands (2.4). There were average signs per admission of ES 4.4, LS 0.6 and LES 0.19. Although there were differences in rates of recordings of signs across the five hospitals, the patterns of top 10 most frequent were similar. Conclusions: There was a high incidence of recordings of disturbed physiological variables in general ward patients. Changes to hospital emergency response systems to include rapidly responding teams to patients with the signs of developing critical conditions should be supported by training programmes for ward staff on the early recognition and management of patients with the warning signs. (c) 2005 Elsevier Ireland Ltd. All rights reserved.