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Patient deterioration out of hours

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I would be interested in hearing from anyone who has done any work on how we monitor patient deterioration overnight? I am currently working on am improvement project looking at patient surveillance of deterioration during night shifts. 

I have chosen this project as part of a Clinical Improvement Scholarship Program I am on.  The program is combined with my day job as a Critical Care Outreach Sister as well as enabling me to develop my research and leadership skills alongside implementing improvements in clinical care. 

I am in the early stages of my work, however I have some literature and local research around deficiencies in how we monitor patients for deterioration overnight (as well as personal experiences as a CCOT nurse) which is why this topic is so important to me.

I would be interested in hearing from anyone who has worked on anything similar, or can point me in the direction of anyone who maybe able to help.

Thank you ?

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HI Emma, good luck with your project. Sounds very valuable and please do share with us on the hub when you've completed it.

I attended a great PS conference at the Homerton Hospital last week. One of the projects that they outlined involved a thematic analysis of deteriorating patients. They used the findings to restructure the resources of the clinical team and night cover as well as changing communication, improving team work etc. You might find it valuable to review. @linniepontin is the Quality and Safety lead. Linnie, can you help?


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I work with @Emma Richardson in the same trust.  We have recently gone 24/7 on one of our sites, plus electronic observations.  Its amazing what goes on / not goes on at night.

Something that I have noticed is the 'culture' of when observations are taken.  Traditionally we have taken them at specific times......06:00, 12:00, 16:00, 20:00 .    Changing to electronic observations disrupts this routine, quite rightly.

The work that @Emma Richardson is doing will highlight what the barriers and enablers are to safer monitoring at night.

I'm really interested to find out!


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Hey @Emma Richardson I must have missed this previously, but just stumbled across your thread. Did you finish your project on this? I would love to read it if this would be possible please?  Sounds really interesting.  What were the main barriers and enablers to safer monitoring at night?  What improvements were highlighted? So many questions!! ☺️ 

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