Barker Robert O, Eastaugh Claire H, Searle Ben, Wallace Sheila A, Craig Dawn, Hanratty Barbara
Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
National Institute for Health and Care Research (NIHR) Applied Research Collaboration North East and North Cumbria, Newcastle, UK.
BMC Health Serv Res. 2025 May 28;25(1):765. doi: 10.1186/s12913-025-12534-x.
Acute deterioration describes a rapid decline in health due to short-duration illnesses. This is an important topic for older adults living in long-term care facilities (LTCF). Signs of acute deterioration are often subtle, and there is no standardised system to manage it. The aim of this review is to scope the range of deterioration tools used in LTCFs, and to describe how they have been evaluated.
A scoping review was conducted in accordance with the Joanna Briggs Institute methodology. Searches of five (MEDLINE, APA PsycInfo, Embase, CINAHL, HMIC) electronic databases (2013-2023, updated 2025) and relevant websites were followed by title/abstract (by two authors independently) and full-text screening. Eligible studies involved tools used to manage acute deterioration for adults > 65 years in LTCFs. Experimental and observational study designs were eligible, including quality improvement projects. No country or language restrictions were imposed. A narrative synthesis was conducted.
Twenty-six studies were included (23 peer-reviewed articles, two conference abstracts, one dissertation) after screening 5958 articles. A majority were from the UK (n = 10) and USA (n = 9), with small numbers from other high-income countries ((Australia (n = 2), Canada (n = 2), Sweden (n = 2), Switzerland (n = 1)). Studies employed a wide range of methodologies, with only one randomised study, and tools were frequently evaluated as part of multi-faceted interventions. The majority of studies described an intervention in which SBAR (situation-background-action-recommendation) (n = 15), National Early Warning Scores (n = 7) or STOP AND WATCH (n = 4) were a component. Studies used quantitative (n = 21) and qualitative (n = 9) methods to evaluate tools. Outcome measures were heterogeneous, with no data on resident experience. The majority of studies concluded potential benefit from using deterioration tools. There is some evidence that LTCF staff perceive tools, especially SBAR, as improving confidence in managing acute deterioration and aiding communication with external healthcare professionals.
Despite policy drivers to use deterioration tools in LTCFs, there is no robust evidence to support this. Direct benefits for resident care have not been demonstrated. Further research is required to compare tools to standard care, measure the impact on resident experience, and to determine if deterioration tools should become part of routine care in LTCFs.
急性病情恶化是指因短期疾病导致的健康状况迅速下降。对于居住在长期护理机构（LTCF）中的老年人来说，这是一个重要的话题。急性病情恶化的迹象往往很细微，并且没有标准化的管理体系。本综述的目的是梳理长期护理机构中使用的病情恶化评估工具的范围，并描述这些工具是如何被评估的。
按照乔安娜·布里格斯研究所的方法进行了一项范围综述。检索了五个电子数据库（MEDLINE、APA PsycInfo、Embase、CINAHL、HMIC）（2013 - 2023年，2025年更新）以及相关网站，随后进行标题/摘要筛选（由两位作者独立进行）和全文筛选。符合条件的研究涉及用于管理长期护理机构中65岁以上成年人急性病情恶化的工具。实验性和观察性研究设计均符合条件，包括质量改进项目。未施加国家或语言限制。进行了叙述性综合分析。
在筛选了5958篇文章后，纳入了26项研究（23篇同行评审文章、2篇会议摘要、1篇学位论文）。大多数研究来自英国（n = 10）和美国（n = 9），其他高收入国家的数量较少（澳大利亚（n = 2）、加拿大（n = 2）、瑞典（n = 2）、瑞士（n = 1））。研究采用了广泛的方法，只有一项随机研究，并且工具通常作为多方面干预措施的一部分进行评估。大多数研究描述了一种干预措施，其中SBAR（情况 - 背景 - 行动 - 建议）（n = 15）、国家早期预警评分（n = 7）或“停止观察”（n = 4）是组成部分。研究使用定量（n = 21）和定性（n = 9）方法来评估工具。结果测量指标各不相同，没有关于居民体验的数据。大多数研究得出使用病情恶化评估工具可能有益的结论。有一些证据表明，长期护理机构的工作人员认为这些工具，尤其是SBAR，能提高管理急性病情恶化的信心并有助于与外部医疗保健专业人员沟通。
尽管有政策推动在长期护理机构中使用病情恶化评估工具，但没有有力证据支持这一点。尚未证明对居民护理有直接益处。需要进一步研究以将这些工具与标准护理进行比较，衡量对居民体验的影响，并确定病情恶化评估工具是否应成为长期护理机构常规护理的一部分。
