International study validates Queensland’s deterioration tools

Monday, November 9, 2020

A joint study between CEQ’s Patient Safety and Quality Improvement Service (PSQIS), the University of Chicago and three hospital and health services has proven the validity of one of Queensland’s clinical deterioration tools.

The Queensland Adult Deterioration Detection System, known as Q-ADDS, is an early warning tool that supports nursing staff to identify adult patient deterioration early and to communicate their concerns to medical staff.

Early signs of deterioration can be seen in changes in a patient’s vital signs such as breathing rate, blood pressure, heart rate and temperature.

Sunshine Coast-based intensivist Dr Victoria Campbell, who co-authored the study, said the Q-ADDS was tested using vital sign data from more than 220,000 patient records over a 10-year period at the University of Chicago Hospital in the United States.

“The study showed that the Q-ADDS was accurate in detecting when a patient’s condition is deteriorating and was comparable or superior to other commonly used paper-based early warning tools,” Dr Campbell said.

Despite the evidence supporting the tool, Dr Campbell said it wasn’t a “silver bullet” for clinical deterioration. “Early warning tools don't replace good practice and judgement. They don't overcome all human error or negate the need for the interpretation of the clinical picture. They simply provide a safety net.”

The Q-ADDS has been used in Queensland since 2012 and – according to Dr Campbell - is unique compared to other paper-based early warning tools. “It combines a vital-sign based scoring algorithm similar to the NEWS tool in the UK with hard trigger limits, similar to the pioneering BTF tool used in NSW. The hard limits add an extra level of safety. It also has an additional escalation tier and is the only tool that quantifies oxygen requirement as a contribution to the score,” she said.

Dr Campbell said the other key component to appropriately responding to a deteriorating patient was the escalation pathway. “Recognition is one component of it but then there's the escalation and the intervention.”

“Prior to this study it was difficult to determine that our early warning tools were working the best they can - could they be better? Importantly the overall conclusion from the Q-ADDS validation from the University of Chicago is that Q-ADDS appears to be the most efficient of the non-digital algorithms.”

With the ongoing move towards the digital hospital, the team is now turning its attention to an advanced digital solution which will leverage machine learning and allow consideration of more than just vital signs (lab results, patient characteristics etc).

“Queensland Health clinicians will continuously work to improve the quality and safety of care to keep patients safe in our hospitals – because that’s our remit and our responsibility,” Dr Campbell said.

The article has been published in the Resuscitation Journal and is available online. The study also involved Darling Downs, Metro South and Sunshine Coast hospital and health services, as well as the University of Queensland.

Last updated: 9 November 2020