Nursing surveillance has been identified as a core clinical process through which organizational conditions may influence patient safety; however, its explanatory role in the relationship between the nurse work environment and patient safety culture is not well established. This study examined whether nursing surveillance practices account for part of the association between the nurse work environment and patient safety culture in medical-surgical units. Cross-sectional data were drawn from 1,597 medical-surgical nurses who participated in the RN4CAST-Australia 2018 survey. The nurse work environment was measured using the Practice Environment Scale-5, nursing surveillance using a validated 16-item scale assessing the frequency of patient assessment practices for early detection of deterioration, and patient safety culture using a validated short form of the Hospital Survey on Patient Safety Culture. Structural equation modeling was used to estimate direct associations between the nurse work environment and patient safety culture and indirect associations via nursing surveillance. A more favorable work environment was directly associated with a more positive patient safety culture and more frequent surveillance practices. More frequent surveillance was also directly associated with a more favorable patient safety culture. In addition, the nurse work environment was indirectly associated with patient safety culture through increased surveillance. These findings suggest that nursing surveillance represents a specific, actionable mechanism linking work environment conditions to patient safety culture. Efforts to improve patient safety may therefore require both structural enhancements to the work environment and targeted strategies to strengthen proactive nursing surveillance.

BACKGROUND:Nurse retention and wellbeing have reached alarmingly low levels in recent years and health systems globally are searching for large-scale systemic solutions to reduce nurse burnout, improve wellbeing, and increase job satisfaction and retention while simultaneously enhancing patient care quality and safety. OBJECTIVE:To evaluate whether a minimum nurse staffing policy intervention in Queensland Australia improved nurse wellbeing, intentions to leave employment, and patient safety. METHODS:This is a quasi-experimental intervention study in which we compared nurse outcomes, patient safety measures, quality of care indicators, and operational failures among 27 hospitals subject to a minimum nurse staffing policy (i.e. intervention hospitals) and 41 hospitals not subject to the policy (i.e. comparison hospitals) at two points in time: prior to implementation of the policy (i.e. baseline) and two years after implementation (i.e. post-implementation). Percentages of nurses with unfavorable outcomes and unfavorable ratings of quality of care and patient safety are reported for intervention and comparison hospitals at baseline and post-implementation of the staffing policy. Fixed effects logistic regression models evaluated the interaction between the intervention effect and the post-implementation period to report the impact of the staffing policy on outcomes. RESULTS:The minimum nurse staffing policy intervention was associated with improvements in staffing, nurse wellbeing and job outcomes, and quality of care and patient safety in the intervention hospitals. Nurses in intervention hospitals had 24 % lower odds of high burnout (OR 0.76, 95 % CI 0.61-0.94, p < 0.05) and 27 % lower odds of job dissatisfaction (OR 0.73, 95 % CI 0.59-0.91, p < 0.01) at post-implementation relative to the baseline; no statistically significant differences in these outcomes were found among comparison hospitals. Job dissatisfaction with workload, professional development, autonomy at work, and work schedule all declined significantly in intervention hospitals and worsened over time in comparison hospitals. Nurse work environment scores improved in the intervention hospitals and worsened in the comparison hospitals. Quality of care, patient safety, and operational failures markedly improved in the intervention hospitals and generally worsened in the comparison hospitals. CONCLUSIONS:The quasi-experimental study design gives policymakers and hospital administrators strong confidence that minimum nurse staffing policy interventions can result in more favorable work environments for nurses, better job outcomes including lower nurse burnout and job dissatisfaction, and improvements in quality of care and safety for patients.

PURPOSE:Little is known about heat loss during procedural sedation. Our descriptive study aimed to examine the pattern and characteristics of heat loss in this population. DESIGN:Continuous temperature monitoring via a zero-heat-flux device examined heat loss among patients receiving procedural sedation for upper and lower endoscopy procedures. METHODS:Adults receiving procedural sedation for lower and complex upper endoscopic procedures at the study hospital on an outpatient basis were included. Temperature was collected prospectively from the zero-heat-flux device. Demographic and clinical data including shivering and thermal comfort were collected from health records or directly from patients. The Gastrointestinal Endoscopy Satisfaction Questionnaire was completed the next day. Change in body temperature was analyzed using linear mixed-model analysis from induction to the end of procedure. FINDINGS:Among the 165 participants, mean body temperature declined to below 36 °C at 45 minutes from induction. A linear trend model from induction estimated that for every 15 minutes of procedural sedation, body temperature decreased on average by 0.19 °C [95% confidence interval -0.18, -0.21]. Almost one-third (30%, 45/164) were hypothermic on arrival to first-stage recovery, increasing to 42% (68/163) on arrival to second-stage recovery. CONCLUSIONS:Patients receiving procedural sedation for endoscopic procedures may experience heat loss comparable to the initial phase of general or neuraxial anesthesia. Active warming and continuous temperature monitoring are yet to be implemented in this population.

AIM:To evaluate the impact of a participatory, action-oriented implementation study, guided by the integrated Promoting Action on Research Implementation in Health Services framework, for optimising pain care processes in a tertiary paediatric emergency department. DESIGN:Hybrid type 3 implementation effectiveness. METHODS:A collaborative appraisal of the context and culture of pain care informed two interdependent action cycles: Enabling nurse-initiated analgesia and involving families in pain care. The Kids Pain Collaborative, an authentic clinical-academic partnership, was central to facilitating successful implementation. Summative evaluation explored the impact of implementation on processes of pain care using an interrupted time series analysis and emotional touchpoint interviews with families. RESULTS:Staff achieved clinically important and sustained improvements in the rate of nurse-initiated analgesia and pain assessment. Family involvement in pain care shifted from task-orientated practices towards more person-centred ways of working and decision-making. As capacity for collective leadership developed, frontline staff found ways to integrate the KPC approach into ED systems to lead pain care innovation beyond the life of the research project. CONCLUSIONS:The Kids Pain Collaborative, as the overarching implementation strategy, created a practitioner-led coalition for change. Successful implementation was facilitated by working with four interdependent principles: Collaborative and authentic engagement; enabling context for cultural transformation; creating safe spaces for critical reflection and workplace learning; and embedding sustainable practice change. IMPACT:A multi-level model of internal-external facilitation enabled sustained improvement in pain care practice. An embedded researcher was pivotal in this process. PATIENT CONTRIBUTION:Authentic engagement of clinicians and families was pivotal in transforming systems of pain care and enabling a culture where "it is not ok for children to wait in pain" IMPLICATIONS FOR PRACTICE: The principles underpinning the Kids Pain Collaborative are transferable to other emergency department and acute care contexts. REPORTING METHOD:Standards for Reporting Implementation Studies checklist.

OBJECTIVE:To determine the incidence of patients presenting in pain to a large Australian inner-city emergency department (ED) using a clinical text deep learning algorithm. MATERIALS AND METHODS:A fine-tuned, domain-specific, transformer-based clinical text deep learning model was used to interpret free-text nursing assessments in the electronic medical records of 235,789 adult presentations to the ED over a three-year period. The model classified presentations according to whether the patient had pain on arrival at the ED. Interrupted time series analysis was used to determine the incidence of pain in patients on arrival over time. We described the changes in the population characteristics and incidence of patients with pain on arrival occurring with the start of the Covid-19 pandemic. RESULTS:55.16% (95%CI 54.95%-55.36%) of all patients presenting to this ED had pain on arrival. There were differences in demographics and arrival and departure patterns between patients with and without pain. The Covid-19 pandemic initially precipitated a decrease followed by a sharp, sustained rise in pain on arrival, with concurrent changes to the population arriving in pain and their treatment. DISCUSSION:Applying a clinical text deep learning model has successfully identified the incidence of pain on arrival. It represents an automated, reproducible mechanism to identify pain from routinely collected medical records. The description of this population and their treatment forms the basis of intervention to improve care for patients with pain. The combination of the clinical text deep learning models and interrupted time series analysis has reported on the effects of the Covid-19 pandemic on pain care in the ED, outlining a methodology to assess the impact of significant events or interventions on pain care in the ED. CONCLUSION:Applying a novel deep learning approach to identifying pain guides methodological approaches to evaluating pain care interventions in the ED, giving previously unavailable population-level insights.

The success of deep learning in natural language processing relies on ample labelled training data. However, models in the health domain often face data inadequacy due to the high cost and difficulty of acquiring training data. Developing such models thus requires robustness and performance on new data. A generalised incremental multiphase framework is proposed for developing robust and performant clinical text deep learning classifiers. It incorporates incremental multiphases for training data size assessments, cross-validation setup to avoid test data bias, and robustness testing through inter/intra-model significance analysis. The framework's effectiveness and generalisation were confirmed by the task of identifying patients presenting in 'pain' to the emergency department.

Background In general, the quality of pain care in emergency departments (ED) is poor, despite up to 80% of all ED patients presenting with pain. This may be due to the lack of well-validated patient-reported outcome measures (PROMs) of pain care in the ED setting. The American Pain Society-Patient Outcome Questionnaire-Revised Edition (APS-POQ-R), with slight modification for ED patients, is a potentially useful PROM for the adult ED, however it is yet to be completely validated.Methods Adult patients, who had presented with moderate to severe acute pain, were recruited at two large inner-city EDs in Australia. A modified version of the APS-POQ-R was administered at the completion of their ED care. Responses were randomly split into three groups and underwent multiple rounds of exploratory and confirmatory factor analysis with testing for construct, convergent, divergent validity and internal consistency.Results A total of 646 ED patients (55.6% female), with a median age of 48.3 years, and moderate to severe pain on arrival, completed the ED-modified APS-POQ-R. Psychometric evaluation resulted in a reduced nine-question tool, which measures three constructs (pain relief and satisfaction (α=0.891), affective distress (α=0.823) and pain interference (α=0.908)) and demonstrated construct, convergent, divergent validity, and internal consistency.Conclusions This new tool, which we refer to as the American Pain Society-Patient Outcome Questionnaire-Revised for the ED (APS-POQ-RED), should form the basis for reporting patient-reported outcomes of ED pain care in future quality improvement and research.

AIM:To develop and internally validate risk prediction models for subsequent clinical deterioration, unplanned ICU admission and death among ward patients following medical emergency team (MET) review. DESIGN:A retrospective cohort study of 1500 patients who remained on a general ward following MET review at an Australian quaternary hospital. METHOD:Logistic regression was used to model (1) subsequent MET review within 48 h, (2) unplanned ICU admission within 48 h and (3) hospital mortality. Models included demographic, clinical and illness severity variables. Model performance was evaluated using discrimination and calibration with optimism-corrected bootstrapped estimates. Findings are reported using the TRIPOD guideline for multivariable prediction models for prognosis or diagnosis. There was no patient or public involvement in the development and conduct of this study. RESULTS:Within 48 h of index MET review, 8.3% (n = 125) of patients had a subsequent MET review, 7.2% (n = 108) had an unplanned ICU admission and in-hospital mortality was 16% (n = 240). From clinically preselected predictors, models retained age, sex, comorbidity, resuscitation limitation, acuity-dependency profile, MET activation triggers and whether the patient was within 24 h of hospital admission, ICU discharge or surgery. Models for subsequent MET review, unplanned ICU admission, and death had adequate accuracy in development and bootstrapped validation samples. CONCLUSION:Patients requiring MET review demonstrate complex clinical characteristics and the majority remain on the ward after review for deterioration. A risk score could be used to identify patients at risk of poor outcomes after MET review and support general ward clinical decision-making. RELEVANCE TO CLINICAL PRACTICE:Our risk calculator estimates risk for patient outcomes following MET review using clinical data available at the bedside. Future validation and implementation could support evidence-informed team communication and patient placement decisions.

Background: Patient safety is threatened when early signs of clinical deterioration are missed or not acted upon. This research began as a clinical-academic partnership established around a shared concern of nursing physical assessment practices on general wards and delayed recognition of clinical deterioration. The outcome was the development of a complex intervention facilitated at the ward level for proactive nursing surveillance. Methods: The evidence -based nursing core assessment (ENCORE) trial was a pragmatic cluster -randomised controlled trial. We hypothesised that ward intervention would reduce the incidence of patient rescue events (medical emergency team activations) and serious adverse events. We randomised 29 general wards in a 1:2 allocation, across 5 Australian hospitals to intervention (n = 10) and usual care wards (n = 19). Skilled facilitation over 12 months enabled practitioner -led, ward -level practice change for proactive nursing surveillance. The primary outcome was the rate of medical emergency team activations and secondary outcomes were unplanned intensive care unit admissions, on -ward resuscitations, and unexpected deaths. Outcomes were prospectively collected for 6 months following the initial 6 months of implementation. Analysis was at the patient level using generalised linear mixed models to account for clustering by ward. Results: We analysed 29,385 patient admissions to intervention (n = 11,792) and control (n = 17,593) wards. Adjusted models for overall effects suggested the intervention increased the rate of medical emergency team activations (adjusted incidence rate ratio 1.314; 95 % confidence interval 0.975, 1.773), although the confidence interval was compatible with a marginal decrease to a substantial increase in rate. Confidence intervals for secondary outcomes included a range of plausible effects from benefit to harm. However, considerable heterogeneity was observed in intervention effects by patient comorbidity. Among patients with few comorbid conditions in the intervention arm there was a lower medical emergency team activation rate and decreased odds of unexpected death. Among patients with multimorbidity in the intervention arm there were higher rates of medical emergency team activation and intensive care unit admissions. Conclusion: Trial outcomes have refined our assumptions about the impact of the ENCORE intervention. The intervention appears to have protective effects for patients with low complexity where frontline teams can respond locally. It also appears to have redistributed medical emergency team activations and unplanned intensive care unit admissions, mobilising higher rates of rescue for patients with multimorbidity. Trial registration number: ACTRN12618001903279 (Date of registration: 22/11/2018; First participant recruited: 01/02/2019). (c) 2024 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Emancipatory practice development (ePD) is a practitioner-led research methodology which enables workplace transformation. Underpinned by the critical paradigm, ePD works through facilitation and workplace learning, with people in their local context on practice issues that are significant to them. Its purpose is to embed safe, person-centred learning cultures which transform individuals and workplaces. In this article, we critically reflect on a year-long ePD study in an acute care hospital ward. We explore the challenges of practice change within systems, building collective strength with frontline collaborations and leadership to sustain new learning cultures. Our work advances practice development dialogue through working closely with the underpinning theories. Our critique analyses how ePD can enact and sustain change within a complex system. We argue that ePD works to strengthen safety cultures by challenging antidemocratic practices through communicative action. By opening communicative spaces, ePD enables staff to collectively deliberate and reach consensus. Their raised awareness supports staff to resist ways of working which conspire against safe patient care. Sustainability of practice change is fostered by the co-operative democracies created within the frontline team and meso level enablement. We conclude that the democratising potential of ePDt generates staff agency at the frontline.

This article presents a contextual review of the literature on mental health policy in the global and Australian settings. The review constitutes an analysis of, firstly, the relevant global literature on mental health policy and practice concepts and, secondly, the Australian literature on mental health policy with a particular focus on the Better Access initiative. Finally, the review offers an analysis of the most recent Better Access evaluation and concludes by considering future directions for the initiative.

BACKGROUND:Pill dysphagia, the difficulty in swallowing solid oral medications, is a common problem that can affect medication adherence and increase pill modifications. Current practices of crushing medications or using food vehicles have limitations and potential risks. This report describes the implementation of a medication lubricant, Gloup, for pill dysphagia on an acute care ward using Plan-Do-Study-Act cycles.OBJECTIVE:The objective of this project was to evaluate the implementation of Gloup in the acute care ward setting and assess its acceptability and uptake by patients and ward nurses during medication administration.METHODS:The project involved chart audits of medication administration records, collection of patient feedback, and staff feedback through meetings. Patient characteristics and medication administration practices were documented. The implementation process included education and training sessions for staff, development of a medication chart sticker for evaluation data collection and small-scale testing of Gloup with patients before ward-level implementation.RESULTS:The implementation of Gloup on the acute care ward showed high uptake and acceptability. The majority of patients using Gloup had crushed medications, and the use of Gloup varied based on patient needs.CONCLUSION:The implementation of Gloup as a medication lubricant for pill dysphagia on an acute care ward was successful and well received by patients and staff. The use of Gloup appeared to improve medication administration practices and reduce the need for crushing medications or using food vehicles. This project highlights the importance of addressing pill dysphagia in acute care settings and provides insights for other wards considering similar interventions.

Background Patients requiring medical emergency team (MET) review have complex clinical needs, and most remain on the ward after review. Current detection instruments cannot identify post-MET patient requirements, meaning patients remain undistinguished, potentially resulting in missed management opportunities. We propose that deteriorating patients will cluster along dimensions of illness severity and that these clusters may be used to strengthen patient risk management practices. Objective To identify and define the number of illness severity clusters and report outcomes among ward patients following MET review. Study design and setting This retrospective cohort study examined the clinical records of 1500 adult ward patients following MET review at an Australian quaternary hospital. Three-step latent profile analysis methods were used to determine clusters using Sequential Organ Failure Assessment (SOFA) and Nursing Activities Score (NAS) as illness severity indicators. Study outcomes were (1) hospital mortality, (2) unplanned intensive care unit (ICU) admission and (3) subsequent MET review. Results Patients were unplanned (73.9%) and medical (57.5%) admissions with at least one comorbidity (51.4%), and complex combinations of acuity (SOFA range 1–17) and dependency (NAS range 22.4%–148.5%). Five clusters are reported. Patients in cluster 1 were equivalent to clinically stable general ward patients. Organ failure and complexity increased with cluster progression—clusters 2 and 3 were equivalent to subspecialty/higher-dependency wards, and clusters 4 and 5 were equivalent to ICUs. Patients in cluster 5 had the greatest odds for death (OR 26.2, 95% CI 23.3 to 31.3), unplanned ICU admission (OR 3.1, 95% CI 3.0 to 3.1) and subsequent MET review (OR 2.4, 95% CI 2.4 to 2.6). Conclusion The five illness severity clusters may be used to define patients at risk of poorer outcomes who may benefit from enhanced levels of monitoring and targeted care.

•A retrospective methodology for the identification of patients presenting in pain.•The prevalence of pain on arrival to this ED over a three-year period was 55.2%.•Pain is identifiable from triage assessments.

BACKGROUNDAlthough progress has been made in identifying and responding to acutely deteriorating ward patients, judgements about the level of care required for patients after medical emergency team review are complex, rarely including a formal assessment of illness severity. This challenges staff and resource management practices and patient safety.OBJECTIVEThis study sought to quantify the illness severity of ward patients after medical emergency team review.RESEARCH DESIGN AND SETTINGThis retrospective cohort study examined the clinical records of 1500 randomly sampled adult ward patients following medical emergency team review at a metropolitan tertiary hospital. Outcome measures were the derivation of patient acuity and dependency scores using sequential organ failure assessment and nursing activities score instruments. Findings are reported using the STROBE guideline for cohort studies.NO PATIENT OR PUBLIC CONTRIBUTIONNo direct patient contact was made during the data collection and analysis phases of the study.RESULTSPatients were male (52.6%), unplanned (73.9%) medical admissions (57.5%), median age of 67 years. The median sequential organ failure assessment score was 4% and 20% of patients demonstrated multiple organ system failure requiring non typical monitoring and coordination arrangements for at least 24 h. The median nursing activities score was 86% suggestive of a near 1:1 nurse-to-patient ratio. More than half of all patients required enhanced levels of assistance with mobilization (58.8%) and hygiene (53.9%) activities.CONCLUSIONSPatients who remain on the ward following medical emergency team review had complex combinations of organ dysfunction, with levels of dependency similar to those found in intensive care units. This has implications for ward and patient safety and continuity of care arrangements.RELEVANCE TO CLINICAL PRACTICEProfiling illness severity at the conclusion of the medical emergency team review may help determine the need for special resource and staffing arrangements or placement within the ward environment.

Background: Monitoring body temperature is essential for safe perioperative care. Without patient monitoring during each surgical phase, alterations in core body temperature will not be recognised, prevented, or treated. Safe use of warming interventions also depends on monitoring. Yet there has been limited evaluation of temperature monitoring practices as the primary endpoint. Objective: To investigate temperature monitoring practices during all stages of perioperative care. We examined what patient characteristics are associated with the rate of temperature monitoring, along with clinical variables such as warming intervention or exposure to hypothermia. Design: An observational period-prevalence study over seven days across five Australian hospitals. Settings: Four metropolitan, tertiary hospitals and one regional hospital. Participants: We selected all adult patients (N = 1690) undergoing any surgical procedure and any mode of anaesthesia during the study period. Methods: Patient characteristics, perioperative temperature data, warming interventions and exposure to hypothermia were retrospectively collected from patient charts. We describe the frequencies and distribution of temperature data at each perioperative stage, including adherence to minimum temperature monitoring based on clinical guidelines. To examine associations with clinical variables, we also modelled the rate of temperature monitoring using each patient's count of recorded temperature measurements within their calculated time interval from anaesthetic induction to postanaesthetic care unit discharge. All analyses adjusted 95% confidence intervals (CI) for patient clustering by hospital. Results: There were low levels of temperature monitoring, with most temperature data clustered around admission to postanaesthetic care. Over half of patients (51.8%) had two or less temperatures recorded during perioperative care and one-third (32.7%) had no temperature data at all prior to admission to postanaesthetic care. Of all patients that received active warming intervention during surgery, over two-thirds (68.5%) had no temperature monitoring recorded. In our adjusted model, associations between clinical variables and the rate of temperature monitoring often did not reflect clinical risk or need: rates were decreased for those with greatest operative risk (American Society of Anesthesiologists Classification IV: rate ratio (RR) 0.78, 95% CI 0.68-0.89; emergency surgery: RR 0.89, 0.80-0.98), and neither warming interventions (intraoperative warming: RR 1.01, 0.93-1.10; postanaesthetic care unit warming: RR 1.02, 0.98-1.07) nor hypothermia at postanaesthetic care unit admission (RR 1.12, 0.98-1.28) were associated with monitoring rate. Conclusions: Our findings point to the need for systems-level change to enable proactive temperature monitoring over all phases of perioperative care to enhance patient safety outcomes. Registration: Not a clinical trial. (c) 2023 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Pain is the most common symptom experienced when presenting to the emergency department (ED). Estimates indicate over half of all patients will present in pain. EDs typically focus on care process measures, such as time to first analgesic medication. Process-based metrics remove the patient from their own experience. Unfortunately, when patient-reported measures of pain care are used in the ED for quality improvement or research, they vary widely and often lack validation. Previous work has demonstrated that a modified version of the American Pain Society – Patient Outcome Questionnaire – Revised Edition (APS-POQ-R) may provide an ideal patient-reported outcome measure for the adult ED population. However, previous work has left validation incomplete. In this multi-site, multistage research, we demonstrate the construct, convergent and divergent validity and the internal consistency of a modified version of the APS-POQ-R in adult patients presenting to two large, inner-city EDs with moderate to severe acute pain. After three stages of psychometric testing in 646 patients, we present a nine-question, three construct patient-reported outcome measure for moderate to severe pain in the adult emergency department, now known as the American Pain Society – Patient Outcome Questionnaire – Revised for the ED (APS-POQ-RED). Perspective This article presents the psychometric properties of a revised version of the APS-POQ-R for use in the adult ED. This shortened, ED-specific patient-reported outcome measure (APS-POQ-RED) seeks to provide a standardised, validated measure of patient-reported outcomes of acute pain care in the ED for quality and research purposes. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This project was funded through The Emergency Medicine Foundation (Australia) grant number EMLE-166R34-2020. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study received approval from the Human Research Ethics Committee of the Royal Brisbane and Womens Hospital (LNR/2019/QRBW/55143). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors.

Introduction Patients requiring Medical Emergency Team (MET) review are a heterogenous population with complex and time-critical needs. The current approach to classifying patients does not consider measures of illness severity and this affects resource and patient management practices.