Summary
The new PIER approach will enable the effective management of acute physical deterioration in health and care and will apply to all conditions, clinical settings and specialities.
The new PIER approach views deterioration as a whole pathway which is supported by systems rather than only advocating a single strategy for identification.
Acute physical deterioration is the rapid worsening of a patient’s condition. It can be identified from changes in physiology, such as respiratory rate, blood pressure or consciousness, or more subtle signs, such as not eating and a patient or their family’s concerns and observations around wellness, mental status or behaviour.
Deterioration can occur in any health and care setting and is the common pathway in all emergency admissions, prolonged illnesses and deaths.
Content
PIER stands for:
- prevention: planning ahead of any episode of deterioration to stop what is preventable, considering indicators of risk and patient choice
- identification: tools and methods to identify when deterioration is occurring in a standardised way
- escalation: timely escalation of care when deterioration has been identified using standardised communication tools
- response: timely, appropriate and effective response to escalation of the deteriorating patient/person.
Benefits:
- Supporting the NHS to manage acute physical deterioration not only saves lives and prevents patients from becoming increasingly unwell but can also reduce the length of a hospital stay allowing resources to be available to benefit other patients.
Implementing the PIER approach:
In Summer 2024, following a variety of testing with colleagues, we will produce a PIER toolkit, containing a range of resources to support integrated care boards (ICBs) to introduce the PIER approach across their local systems.
The toolkit will support and guide ICBs with pathway/system thinking for deterioration management that is system led. This suite of resources will help ICBs to use an improvement approach to design and implement a deterioration improvement plan that follows 7 key phases:
- set up
- building the ICB vision
- mapping the ICB
- improvement planning
- operationalising
- improvement action
- evaluation and sustainability.
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