• Julie Considine, Daryl Jones, and Rinaldo Bellomo.
• aDeakin University-Northern Health Clinical Partnership, Burwood bDepartment of Intensive Care, Austin Health, Heidelberg cAustralian and New Zealand Intensive Care Research Centre, Monash University, Prahran, Victoria, Australia.
• Eur J Emerg Med. 2013 Dec 1;20(6):375-81.

ObjectivesThe aim of this paper, is to present a case to develop and test emergency department (ED)-specific approaches to improve the sequential detection, recognition and timely escalation of care for ED patients who have deteriorated after their initial triage and assessment.ResultsManaging the risk of clinical deterioration is a key feature of emergency care and underpins practice. However, although the epidemiology of deterioration in hospitalized ward patients has been well studied, the epidemiology of deterioration in ED patients is less understood. As ED workloads continue to increase, an emerging challenge for ED clinicians is how best to recognize and rapidly respond to deteriorating ED patients following triage and/or medical assessment. Rapid response systems for such patients exist in hospital wards; however, the use of rapid response systems in EDs is variable and largely unknown outside the UK.ConclusionA systematic approach to the early recognition of, and response to, deteriorating ED patients across the entire ED trajectory of care remains untested. Given the complexities of the ED environment, ward-based models of recognizing and responding to deteriorating patients may not meet the specific needs of the ED.

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