The Commission is running a five-year national patient deterioration programme from 1 July 2016. It aims to reduce harm from failures to recognise or respond to acute physical deterioration for all adult inpatients (excluding maternity) by July 2021.

Current status

We are seeking comments and feedback from clinicians, hospitals, colleges and associations on the proposed elements of the national recognition and response system by 22 May 2017. Click here to find out more and how you can take part.

We are working with six early implementer hospitals to test and refine the elements of the system and the range of tools and guidance to support it. Once the refined tools and guidance are available they may need to modify their systems and spread across their hospital(s) as part of the wider implementation.

Patient deterioration timeline 2017

We recommend other hospitals:

  • Map their current recognition and response systems to identify the challenges and opportunities for improvement.
  • Understand what data they currently collect about their recognition and response systems, including:
    • inpatient cardiac arrest rates per 1000 admissions
    • unplanned ICU admission rates per 1000 admissions
    • compliance with current processes for vital sign documentation, escalation of care and response to deterioration.

About acute physical deterioration

Acute physical deterioration can happen at any point during a patient’s admission to hospital. Many patients show signs and symptoms of physiological instability for some time before events such as cardiac arrest or unplanned admission to an intensive care unit (ICU). This means there are opportunities to intervene and prevent these events from occurring.

A patient whose clinical condition is deteriorating needs timely recognition and appropriate expert care. In New Zealand, there is currently variation in:

  • vital sign charts and early warning scores
  • skills and knowledge of responders
  • availability of responders in hospitals 
  • clinical governance and monitoring arrangements.

Patients, families and whānau often recognise subtle signs of patient deterioration, even if vital signs are normal, but clinicians respond variably to these concerns. Acting on these concerns, discussing patients’ preferences for care early, and making shared decisions about the goals of an episode of care can improve communication, provide better experiences for all involved and ensure appropriate responses to acute deterioration.

Programme timelines

Over five years the programme will work with hospitals to establish recognition and response systems for managing the care of acutely deteriorating patients. The initial focus will be on getting the basis of the system in place (workstream one). Then the focus will change towards embedding patient, family and whānau escalation processes (workstream two) and approaches to shared goals of care (workstream three). The current programme timeframe is:

Patient deterioration programmes timeline 2017

See the programme charter for more information about the programme.

Dave’s story

Dave Churchman and his wife Diane share their story of life for Dave after his diagnosis of cancer.  Dave was literally up a ladder striping the wallpaper at home when he realised he was feeling very unwell. The backdrop of the stripped back wall in this video is a symbol of a life interrupted. Dave and his wife share their experiences about their interactions with their GP and the hospital after Dave’s diagnosis.  It is about communication, advance care planning and the language used in patient care. 

Background to the programme

In late 2014, Sapere Research Group developed an investment case  for a patient deterioration quality improvement programme.

Between October 2015 and April 2016, we spoke with people in the sector to inform the development of the programme and reviewed the evidence in the literature and work being done internationally.  See the following reports:

The programme team includes clinical, consumer, quality improvement, measurement and project management expertise.  Dr Alex Psirides, an intensive care consultant at Capital and Coast DHB, is the clinical lead for the programme.  An expert advisory group provides advice to the programme and includes consumer, clinical and academic representatives.

In March 2016 we hosted a workshop with Associate Professor Jeanne Huddleston in partnership with the Health Roundtable.  Presentations are available here.


Featured projects, news or publications

Programme related news