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Improving care for deteriorating patients

Improving the identification and management of deteriorating patients is a major patient safety priority for the NHS, and every healthcare system in the world.

Improving the identification and management of deteriorating patients is a major patient safety priority for the NHS, and every healthcare system in the world.

Since 2014, UCLPartners has supported its partner NHS organisations to improve the identification and management of people at risk of deterioration. This work supports the priorities of NHS organisations within our region, as well as being aligned to national efforts and the work of the Patient Safety Collaborative programme.

We have different strands of work testing and spreading interventions across a range of health and social care settings.

NEWS2 in acute settings

In order to achieve our aims, we convened the Deteriorating Patient Network that brings together around 50 representatives from partner organisations to collectively explore the challenges, opportunities and learning from work to improve the identification and management of deteriorating patients in acute setting. A particular focus for the network so far has been to support the implementation of NEWS2, the National Early Warning Score, as well as other ideas and innovations to improve outcomes for deteriorating patients.  All acute trusts in our region are now using the updated NEWS2, as recommended by the Royal College of Physicians.

NEWS2 and Softer Signs of deterioration in Health & Social Care

Building on the work already done in the region to allow a common language to recognise, escalate and communicate deterioration, we are now looking to test and scale up NEWS2 and a soft signs of deterioration approach in non-acute and community settings.

A significant number of individuals with complex needs receive care in the community: at home, in care homes or in specialised supported accommodation (for people with learning disabilities). This population often has high support needs and adverse safety events can quickly escalate. Their ongoing care is delivered mostly by non-clinically trained care staff who do not always have the confidence and competence to recognise physical deterioration in people they care for. This can result in inappropriate escalation and unnecessary hospital admissions.  Studies have also shown that nursing assistants in a care home can spot signs of illness before they were seen in clinical observations. Empowering and equipping these staff with the skills and knowledge to recognise and escalate deterioration appropriately is pivotal in preventing unnecessary hospital admissions, which can often be disruptive and unsettling for the elderly and people with learning disabilities. 

We are running a programme to improve the experience and outcomes for people cared for in the community who are at risk / experiencing deterioration, by training and supporting non-clinically trained staff to recognise, escalate and communicate signs of deterioration in a timely and appropriate fashion.

We are working with four commissioners / providers of health and social care services across:

  • North London Partners Health and Care STP
  • London Borough of Newham
  • East London NHS Foundation Trust
  • Southend CCG

To test and implement two innovative approaches:

  • the Significant 7+ training and toolkit to detect the soft signs of deterioration, helping staff to assess the situation and escalate appropriately.
  • the Whzan digital telehealth solution to undertake clinical observations, calculate a NEWS2 score and respond quickly through appropriate escalation routes.

These interventions will be tested across a diverse group of providers including: 

  • home care with domiciliary care providers
  • residential and/or nursing care homes
  • community nursing
  • carer organisations
  • specialised supported accommodation for people with a learning disability.

The programme is delivered in partnership with North East London Foundation Trust (NELFT) who has developed the Significant 7+ and Solcom Ltd, company that has developed Whzan digital solution.

Teams received the Whzan free portable monitoring kit(s) and / or the Significant 7+ the train the trainer package alongside annual subscriptions. They are also benefiting from being part of the wider Deterioration Patient Network and ongoing quality improvement support provided by UCLPartners.  

If you would like to know more about this work, please email Valentina Karas, Patient Safety Programme Manager, at