• An NHS Borders project.
  • An initiative to be tested in a community hospital and out-of-hours service covering one geographic area in the Borders.
  • Aims to improve recognition of, and care for, deteriorating patients and reduce mortality, length of stay and undue distress.
  • Involves the development of a reliable model for recognising these patients in the community setting, and designing an appropriate response to ‘rescue’ the patient.

There is currently no standardised way of recognising patients who are deteriorating in the community setting and communicating this across the care interfaces. As moves to provide more care in the community continue, it is important that there is clear decision making support for recognition of deteriorating patients.

Early recognition of symptoms of deterioration allows for early intervention and treatment, reducing mortality and morbidity. It also enables more efficient use of health care resources and reduces length of hospital stay.

NHS Borders has four community hospitals where patients with a variety of conditions are provided with rehabilitation, palliative care or step-down care following an acute admission. In addition, the health board runs a community out-of-hours service, led by nursing staff and GPs.

The acute hospital, the Borders General Hospital, has a reliable system for recognising the deteriorating patient and responding appropriately to ‘rescue’ the patient. This project involves designing a model which would be fit for purpose in the community hospital and community out-of-hours service. The model will be tested using improvement methodology to gain reliability before spread.

The aim of the project is to ensure 100% of patients in the test sites receive reliable and timely early warning scores, and that a reliable escalation procedure is followed.

It is anticipated that the model will apply to over half of the patients within the community hospital setting at any one time – equating to between 40 and 50 patients a day.


Sarah Chalmers

I am involved in creating a "District Nursing Risk Assessment Bundle" including "Care rounding tool" for use with out DN teams in Lothian.
We are interested in adding in information that would capture the deteriorating patient. We are struggling to find anything that is relevant for community and wondered if you had any infomation that would help.
I would be grateful for any guidance you can give.

Joanne Lawley

Hi Sarah have you had a chance to review NHS Lanarkshire's Structured Response? This is a tool that has been developed specifically for community nurses responding to the deterioating patient at home.

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