4 Research recommendations

Identification and evaluation of risk scoring tools

  • What is the clinical effectiveness and cost effectiveness of automated (electronic) monitoring systems compared with manual recording systems in identifying people at risk of clinical deterioration in general hospital ward settings?

  • What are the sensitivities and specificities of track and trigger systems in different clinical settings?

  • Can track and trigger systems that have higher sensitivities and specificities than existing scores be developed and validated?

Response strategies for patients identified as having a deteriorating clinical condition

  • What is the clinical and cost effectiveness of a structured educational programme to improve recognition of and response to acute illness compared with no structured programme in improving outcomes for people who clinically deteriorate in general hospital ward settings?

  • What is the clinical and cost effectiveness of CCOS compared with usual care or educational outreach in improving health outcomes for patients who clinically deteriorate in general hospital ward settings? Such research should:

    • use a cluster RCT design conducted on multiple sites, with analysis of the cluster at hospital level rather than ward level

    • investigate a range of health outcomes, including mortality, morbidity, quality of life measures and patient satisfaction

    • include a parallel qualitative process evaluation to help establish which components of outreach (a complex intervention) are likely to be most effective

    • consider 24-hour critical care outreach as well as daytime outreach.

Transfer of patients from critical care areas

  • What is the clinical and cost effectiveness of providing structured educational advice (such as an information booklet) compared with usual care to patients who have been transferred from critical care areas back to general hospital ward settings?

  • What is the clinical and cost effectiveness of a transfer facilitator for patients transferred from critical care to a general ward environment? Such research could include outcome measures on:

    • patient satisfaction

    • time to discharge from acute hospital

    • destination when transferred.

  • National Institute for Health and Care Excellence (NICE)