Pain Charles, Green Malcolm, Duff Colette, Hyland Deborah, Pantle Annette, Fitzpatrick Kimberley, Hughes Cliff
Top End Health Service, Department of Health, Rocklands Drive, Tiwi 0810, Northern Territory.
Systems Improvement, Clinical Excellence Commission, Level 17 McKell Building, 2-24 Rawson Place Sydney 2000, NSW, Australia.
Int J Qual Health Care. 2017 Feb 1;29(1):130-136. doi: 10.1093/intqhc/mzw132.
In 2005, the Clinical Excellence Commission (CEC) found that unrecognised patient deterioration remained an important problem in New South Wales (NSW) public hospitals.
The challenge was to design and implement an effective and sustainable safety-net system in all 225 NSW public hospitals.
The CEC's system was designed in collaboration with a broad coalition of partners, including clinicians, managers, system administrators and collaborating agencies. A five-element system comprising governance, standard calling criteria in standard observation charts, two-level clinical emergency response systems (CERS) in each facility, an education programme and evaluation, was designed for state-wide implementation. This system was called 'Between the Flags' (BTF).
Implementation was led by the CEC on behalf of a NSW coalition, and commenced in January 2010 with the implementation of the Standard Adult General Observation Chart, awareness training for all staff and a CERS in each facility.
Since the introduction of BTF, the cardiac arrest rate has declined by 42% (P < 0.05) and the Rapid Response rate has increased by 135.9% (P < 0.05) in NSW. The strength of staff support for BTF has grown with the proportion of respondents strongly agreeing that BTF has benefitted patient safety more than doubling from 21% to 44%, and overall agreement rising from 68% to 82% between 2010 and 2012.
Key success factors are a focus on governance, standardisation of observation charts and striking the right balance between a rule-based approach and individual clinical judgement.
2005年，临床卓越委员会（CEC）发现，患者病情未被识别的恶化情况在新南威尔士州（NSW）公立医院仍是一个重要问题。
面临的挑战是在新南威尔士州所有225家公立医院设计并实施一个有效且可持续的安全网系统。
临床卓越委员会的系统是与包括临床医生、管理人员、系统管理员和合作机构在内的广泛合作伙伴联盟共同设计的。设计了一个包含治理、标准观察图表中的标准呼叫标准、每个机构的两级临床应急响应系统（CERS）、教育计划和评估的五要素系统，以便在全州实施。这个系统被称为“旗帜之间”（BTF）。
实施工作由临床卓越委员会代表新南威尔士州联盟牵头，于2010年1月开始，实施标准成人综合观察图表、对所有员工进行意识培训以及在每个机构建立临床应急响应系统。
自引入“旗帜之间”系统以来，新南威尔士州的心脏骤停率下降了42%（P < 0.05），快速反应率提高了135.9%（P < 0.05）。员工对“旗帜之间”系统的支持力度有所增强，强烈同意该系统对患者安全有益的受访者比例从21%大幅增至44%以上，总体同意率在2010年至2012年间从68%升至82%。
关键的成功因素包括注重治理、观察图表的标准化以及在基于规则的方法和个人临床判断之间取得恰当平衡。
