Early recognition of a deteriorating patient is one of the most important skills in healthcare. Failure to identify deterioration in time can lead to cardiac arrest, unplanned ICU admission, or death. Conversely, early recognition and prompt escalation save lives.
This blog explains how to recognise the deteriorating patient, key warning signs, assessment tools, and what actions healthcare professionals should take—aligned with Immediate Life Support (ILS) and NHS best practice.
What Is a Deteriorating Patient?
A deteriorating patient is someone whose clinical condition is worsening, often due to:
- Infection or sepsis
- Respiratory failure
- Cardiac problems
- Bleeding
- Metabolic imbalance
- Neurological decline
Deterioration may be subtle at first, making vigilance and structured assessment essential.
Why Early Recognition Matters
Early recognition:
✔ Prevents cardiac arrest
✔ Reduces ICU admissions
✔ Improves survival and outcomes
✔ Supports patient safety and quality care
Many serious adverse events are preceded by abnormal vital signs hours earlier.
Common Causes of Clinical Deterioration
- Sepsis and infection
- Hypoxia or respiratory compromise
- Acute coronary syndromes
- Arrhythmias
- Dehydration or electrolyte imbalance
- Stroke or reduced consciousness
- Medication errors
Understanding these causes helps clinicians anticipate risk.
Key Warning Signs of Deterioration
1. Abnormal Vital Signs
Changes in:
- Respiratory rate (often the earliest sign)
- Oxygen saturation
- Heart rate
- Blood pressure
- Temperature
📌 A rising respiratory rate is one of the strongest predictors of deterioration.
2. Changes in Consciousness
- New confusion or agitation
- Reduced responsiveness
- Drop in GCS or AVPU score
These may indicate hypoxia, sepsis, stroke, or metabolic issues.
3. Increased Oxygen Requirements
- Needing more oxygen to maintain saturations
- Falling SpO₂ despite oxygen therapy
4. Reduced Urine Output
- Less than 0.5 ml/kg/hour
- Sign of dehydration, sepsis, or renal failure
5. Patient, Family or Staff Concern
Never ignore:
- “This patient doesn’t look right”
- Family expressing concern
- Gut instinct from experienced staff
Clinical intuition is a recognised safety indicator.
ABCDE Assessment: The Gold Standard
The ABCDE approach is the safest and most structured way to assess a deteriorating patient.
A – Airway
- Is the airway patent?
- Signs of obstruction (snoring, gurgling)?
B – Breathing
- Respiratory rate
- Oxygen saturation
- Use of accessory muscles
- Breath sounds
C – Circulation
- Heart rate and rhythm
- Blood pressure
- Capillary refill
- Skin colour and temperature
D – Disability
- Conscious level (AVPU/GCS)
- Blood glucose
- Pupillary response
E – Exposure
- Temperature
- Rashes, bleeding, wounds
- Signs of infection or trauma
📌 Treat life-threatening problems as you find them.
Early Warning Scores (NEWS2)
In the NHS, NEWS2 (National Early Warning Score 2) is widely used to identify deterioration.
What NEWS2 Measures
- Respiratory rate
- Oxygen saturation
- Supplemental oxygen
- Temperature
- Systolic blood pressure
- Heart rate
- Level of consciousness
Higher scores = greater clinical risk and need for escalation.
Escalation & Calling for Help
When to Escalate
- Rising NEWS2 score
- Failure to respond to treatment
- Sudden clinical change
- Staff or family concern
Who to Escalate To
- Senior nurse or doctor
- Rapid Response Team / Outreach Team
- Medical Emergency Team (MET)
📌 Early escalation is good practice, not failure.
Communication: SBAR
Use SBAR for clear handover:
- Situation
- Background
- Assessment
- Recommendation
This ensures critical information is shared quickly and accurately.
Recognising Deterioration in ILS
In Immediate Life Support (ILS), early recognition is the first link in the Chain of Survival.
ILS emphasises:
- ABCDE assessment
- Early warning scores
- Timely escalation
- Team communication
Recognising deterioration early can prevent cardiac arrest altogether.
Common Barriers to Early Recognition
⚠ Failure to monitor vital signs regularly
⚠ Over-reliance on single parameters
⚠ Poor communication
⚠ Lack of confidence in escalation
⚠ Underestimating subtle changes
Addressing these barriers improves patient safety.
How Healthcare Professionals Can Improve Recognition
✔ Regular observations
✔ Trend vital signs, not single readings
✔ Trust clinical judgement
✔ Use structured tools (ABCDE, NEWS2)
✔ Encourage a culture of speaking up
Final Thoughts
Recognising the deteriorating patient is a core clinical skill for all healthcare professionals. By using structured assessments, early warning scores, and timely escalation, clinicians can intervene early—often preventing cardiac arrest and saving lives.
Early recognition + early action = better outcomes.
