Acutely ill adults in hospital: recognising and responding to deterioration

Reason for the decision

We found a total of 29 new studies through surveillance of this guideline: 14 in a search of systematic reviews and randomised controlled trials (between September 2010 and October 2015) and 15 identified by topic experts. This included new evidence on track and trigger systems, critical care outreach services, and care on the general ward following transfer. None of the new evidence considered in surveillance of this guideline was thought to have an effect on current recommendations.

We did not find any new evidence on physiological parameters to be used by track and trigger systems, or timing of transfer of a patient from critical care areas to general wards.

We found new evidence related to the research recommendations on automated monitoring systems and rapid response services costs. This new evidence was not considered to fully address these research recommendations or affect current recommendations. We did not find any new evidence that would affect other research recommendations.

All topic experts consulted about the surveillance review considered the guideline still relevant to clinical practice. They highlighted some implementation issues related to critical care outreach teams or rapid response teams (or response strategy) as these still do not exist in all trusts.

Topic experts also highlighted the costs associated with the introduction of new technologies in this field and their affordability by NHS trusts. Topic experts also made us aware of the introduction of the National Early Warning Score (NEWS) system into many trusts. However, they highlighted that NEWS has all the limitations of existing early warning systems and its accuracy remains to be confirmed. Topic experts also mentioned the need to place more emphasis on staff education, detection of delirium, rehabilitation after critical illness, and end of life care. However, all these areas are already covered in other NICE guidelines. Topic expert feedback also highlighted some inequalities in access to services or service provision that are not being addressed in the current guideline: this related to a need for a similar approach for children and for a specific early warning score for use during pregnancy. However, children are out of scope of this guideline. Specific track and trigger systems for use during pregnancy will be logged for consideration during the development (or surveillance) of relevant guidelines covering this population.