According to this study:

* Previous studies have found that unrecognized clinical deterioration on general care units results in greater severity of illness and increased mortality rates and hospital costs.

Unrecognized clinical deterioration in patients on general care units results in late admission to the ICU and consequently greater severity of illness and increased mortality rates and hospital costs. Other research suggests that cardiac arrest in hospitalized patients is "a late and predictable event with an appalling prognosis that is preceded by eight to 12 hours of clinical deterioration." Factors in the failure to respond to early signs of critical illness have been identified in the literature: a shortage or inappropriate use of experienced senior nurses, inexperienced residents, and a failure to recognize clinical deterioration.

The objective of the present study was to test various signs and symptoms for sensitivity and specificity in predicting clinical deterioration in postoperative patients. Data pertaining to two groups of postoperative patients were collected-one group of 69 patients received care on a "surgical high-dependency unit" and were then returned to "ward-based care"; another group of 67 patients needed to be transferred to the ICU after clinical deterioration on the same high-dependency unit.

The authors found that heart rate, respiratory rate, and oxygen saturation were significantly predictive of clinical deterioration. The patients in the two groups were distinguishable from each other according to heart rate and respiratory rate as early as seven and eight hours before admission to the ICU, respectively, and according to oxygen saturation as early as 48 hours prior to admission.

Given the considerable costs and detriment to health associated with unrecognized clinical deterioration, nurses could make good use of accurate and reliable early-warning scoring systems.

CC