Page 2672 - Week 08 - Wednesday, 21 September 2022
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The systematic review found that there are still gaps in the current evidence base regarding these systems and tools. We will look at these to effectively determine their specific use. Future research is still needed to understand the full evidence base.
There are a number of considerations for implementing a paediatric track and trigger system, which also include scoring thresholds. These can be different depending on the protocol in use, of which there are many. The fact that New South Wales and Victoria have different systems, and Ms Castley is not providing a recommendation about which one should be used, is an indication that there are different systems in place. The systematic review found:
… at lower triggering thresholds, sensitivity is high but specificity is low; at higher thresholds, the opposite is true.
It stands to reason. This means, depending on the thresholds that are set, you might have significantly higher detection of “derangement”, the clinical term, but it might not be specific to deterioration. These kinds of issues, which are very technical, I understand, have implications and unintended consequences for the patient, who may become subject to unnecessary interventions. They also have implications for the clinical practice of clinicians who are managing day-to-day patient care.
The tool used to score vital signs is just one element of the entire early warning system, and this map does need to be kept in mind when we, as politicians, are talking about clinical systems and their everyday use in clinical practice. We are not just talking about a simple protocol change.
The early warning system is talking about processes that extend throughout the hospital and the way escalation occurs within a single team, to medical emergency teams, to critical care outreach teams and to the broader speciality network that encompasses the entire management of deteriorating patients. A change to even one part of that system, without knowing the evidence base for that change or considering the local context implications, can have significant, serious, knock-on effects for other parts of the system.
The paediatric early warning system has been reviewed over the past 12 months to consider the ongoing application and effectiveness for identifying and responding to a deteriorating child, particularly in the context of implementing the Digital Health Record in November this year.
This examination of the paediatric warning system has included input from a range of clinicians, case analyses, and consideration of national and international literature on alternative warning systems. There is no clear evidence in the available literature that any single system is better than others in terms of identifying deteriorating patients and avoiding negative outcomes.
In 2016, the College of Intensive Care Medicine of Australia and New Zealand, and the Australia and New Zealand Intensive Care Society, released a joint position
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