Lesson 01 of 03

What's at stake

Most in-hospital cardiac arrests show warning signs in the 24 hours beforehand. The signs are there. The question is whether they're seen in time.

Clinical deterioration rarely happens without warning. In the hours before a cardiac arrest, rapid response call, or unplanned ICU admission, a pattern emerges - a drift in vital signs, a change in mental state, a subtle complaint from the patient that something isn't right.

The system is designed to catch it. Observation charts, track-and-trigger thresholds, escalation pathways. But the system only works if someone recognises the drift and acts on it.

"Up to 80% of patients who deteriorate on a general ward show documented warning signs in the preceding 8-24 hours."

Australian Commission on Safety and Quality in Health Care

The cost of missing the drift

When early signs are missed, the consequences escalate quickly. The numbers below come from Australian audits of in-hospital cardiac arrests and failure-to-rescue events.

80%

of cardiac arrests show warning signs in the preceding 24 hours

4x

higher mortality when deterioration is recognised late

52%

of RRT calls occur after criteria have been met for over 2 hours

By the end of this module, you will:

Recognise the track-and-trigger thresholds that indicate clinical deterioration, use ISBAR to communicate concerns clearly, and apply the five-minute decision framework when a patient's status shifts.

Lesson 02 of 03

Track and trigger

The observation chart is your early-warning system. Learn to read it the way it was designed to be read.

Every major Australian health service uses a track-and-trigger system - often the Standard Adult Deterioration Observation Chart (SADOC) or a local variant. Each vital sign has a set of thresholds mapped to a colour. When a value crosses into the coloured zone, a response is triggered.

The trap: individually, a single yellow flag looks benign. The skill is seeing them together, and seeing the trend.

Interactive - Tap each indicator

Reading the observation chart

Each vital sign has a safe range and escalation zones. Tap the coloured markers to see what each threshold means and when to act.

Respiratory rate

Oxygen saturation

Systolic BP

Heart rate

Consciousness (AVPU)

Select any threshold above to see the trigger response.

Communicate with ISBAR

When you escalate, a structured handover cuts through the noise. ISBAR gives senior staff the information they need to decide and act.

Interactive - Tap each step

Knowledge Check

Your patient's respiratory rate has climbed from 18 to 23 over two sets of obs, heart rate is 108, and they say they're "just a bit puffed". What's the right call?

Correct

Two parameters trending in the same direction, plus the patient's own report, is enough to escalate. The chart is a tool for detection, not a permission slip for delay. Yellow zones are prompts to act, not to wait.

Lesson 03 of 03

The 5-minute decision

It's 0347. Your patient doesn't look right. What happens in the next five minutes shapes the rest of the shift.

Most deterioration decisions compress into a small window. You notice something. You weigh it. You act - or you don't. The scenario below puts you in that window. There are no trick questions; every option has real-world justification. But only one is right.

Branching Scenario

Night shift - 0347

General medical ward 5 minutes to decide

MH

Mr Harper, 68

Day 2 post-bowel resection · COPD · On 2L O2 via nasal prongs · Last obs 0000h: RR 18, HR 84, BP 128/72, SpO2 96%, afebrile

You're doing a routine check at 0347. Mr Harper is awake. He says he's "fine, just a bit warm". When you take his obs his resp rate is 24, SpO2 is 91% on 2L, HR 112, BP 98/58. He's diaphoretic. His abdomen looks slightly more distended than earlier. Your gut says something has shifted.

What do you do in the next five minutes?

What good looks like

The correct call isn't about bravado or caution - it's about matching the response to the data. Four parameters drifted in the same direction, the patient's presentation changed, and your gut agreed with the chart. That's the threshold for urgent review.

ISBAR to the med reg is the right instrument for this picture. If they can't come within your timeframe, or if he crosses further into the red zone while you're waiting, MET is the next escalation. The chart, your judgement, and the structured handover work as a unit.