• Run by NHS Borders in partnership with SB Cares (Scottish Borders Council).
  • Tested in a community hospital and out-of-hours service.
  • Aimed to improve and standardise the early recognition of deteriorating patients in the community setting to allow timely intervention and treatment.
  • Involved adapting and implementing a reliable, acute care system for identifying patients with symptoms of deterioration and responding appropriately to ‘rescue’ them.

As the amount of care provided in the community increases, it is important to have a standardised way of identifying patients who are deteriorating in this setting. Recognising symptoms of deterioration early allows for timely intervention and treatment, which improves care and enables more efficient use of health care resources.

The Borders General Hospital has a reliable approach to recognising deteriorating patients and responding appropriately to ‘rescue’ them, which incorporates the National Early Warning Score (NEWS) system.

For this project, NHS Borders saw the potential to reproduce and adapt this acute care model to develop a new system that was fit for purpose in Borders community settings. The aim was to ensure that all patients in the community test sites received a timely NEWS and that a reliable escalation procedure was followed.

Community health care staff were trained to use an adapted NEWS chart to score patients following twice-daily observations. They also used a structured communication tool (detailing the Situation, Background, Assessment and Recommendation – SBAR) for all verbal and written referrals. This systematic approach helped staff to effectively assess patients and confidently ‘escalate’ their care to a GP or emergency department if needed.

Overall, the project opened up and improved communication channels and successfully up-skilled community health care staff. Importantly, it fostered a more proactive approach to anticipatory care planning, which has improved patient safety. In particular, the introduction of a ‘patient escalation decision-making record’ documenting patients’ wishes and treatment plans has resulted in fewer inappropriate transfers and resuscitation attempts.

A collaborative approach was used to identify challenges and barriers to implementation, with regular meetings helping to successfully engage community nursing teams and solve practical issues, such as the need for more equipment. Staff feedback following implementation has been extremely positive and revealed a strong willingness and commitment to sustaining the development of this standardised approach to the care for deteriorating patients in the community setting.

This Innovating for Improvement project ran from the beginning of May 2015 until the end of July 2016.


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.

Diane Wilson

Hi, I am currently developing a new service model to manage deteriorating patients in the Community and have adapted the current NEWS that we have from the acute hospital setting. I would be very keen to see any information or tools that you are using to manage this group of patients and any research that you may have to aid my journey. The service is embedded into our District Nursing service and although the acute component is separate I am keen for all staff to use a tool and have training in this area
many thanks Diane

Clara Morrish

Hi Diane,
Thank you for your comment and interest in this piece of work. Please contact the lead for this project directly - Dr Nicola Lowdon by emailing Nicolalowdon@hotmail.com
Best wishes, Clara, Communications team

Add new comment

* indicates a required field

Your email address will not be published on the site and will only be used if we need to contact you about your comment.

View our comments policy