• 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.