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When a Patient Goes Downhill

Most patients in a hospital get better and go home. But they can also develop unexpected new symptoms, such as a new and unexplained pain or fever, or unfavorable changes in their vital signs. This downward trend can sometimes be difficult to distinguish from the normal ups and downs of illness or recovery, but it can go on for hours or days if not addressed. We call this patient deterioration.

In the quest for patient safety and well-being, recognizing and responding to the signs of a deteriorating patient is paramount. This compilation of resources offers valuable insights, tools, and perspectives to empower patients, families, and healthcare professionals in safeguarding against adverse outcomes. From poignant personal stories to evidence-based guidelines and global charters, these resources provide a comprehensive toolkit for understanding, identifying, and addressing the early warning signs of patient deterioration. Together, they advocate for a collaborative approach to healthcare, where communication, education, and proactive engagement play pivotal roles in ensuring the best possible care outcomes.

Links and Resources


World Patients Alliance webinar
The Deteriorating Patient: When a hospital patient unexpectedly goes downhill, what can families do?

BBC Today: Call for right to second opinion after tragic teen death
Moving interview with Merope Mills that led to the call for reform

Implementation of Martha’s Rule
National Health Service, England



Signs of a Deteriorating Patient
‘Soft signs’ that can help detect deterioration without measuring vital signs


Patient Wellness Questionnaire
Asking patients about their well-being can detect deterioration earlier.


Quick Tips for Families
Raising concerns with health professionals in the hospital




Raising concerns about a deteriorating patient
What families and friends should know



Merope Mills, The Guardian
How shocking hospital mistakes led to our daughter’s death



MDCalc by Gary Smith
Calculates the degree of illness of a patient based on NEWS 2 vital signs and recommends next steps

NHS National Early Warning Score (NEWS 2)
A tool for assessing patient deterioration


Tools for speaking to health professionals
Communication tactics from TeamSTEPPS®


When patients (and families) raise the alarm
Patient and family activated rapid response as a safety strategy for hospitals.

Martha's rule
The complementary roles of clinicians and patients in improving safety of patients deteriorating in hospital

Videos

How do you raise concerns about a patient’s condition in the hospital?

English

Spanish

When you visit your doctor, how can you be sure you're receiving the right diagnosis?

English

Spanish

An introduction to Medication safety

English

Spanish

How many medications are too many?

English

Spanish

How do you talk to your healthcare provider?

English

Spanish