Acute Deterioration in Long-Term Care: A Delphi Study of Indicators, Care Pathways and Implementation Strategies

This study aimed to develop recommendations for acceptable physical and psychological clinical indicators of acute deterioration and strategies to support sustained adoption of an approach to detecting and responding to acute deterioration in long-term care.

Previous studies have trialled programmes to reduce avoidable hospital transfers through early detection of acute deterioration in long-term care. However, variability in outcomes and implementation experiences highlights differences in the essential components of these approaches.

Three-round Delphi process.

The Delphi process conducted between September 2022 and January 2023 included a 22-member Australian expert panel to elicit consensus and to generate recommendations. Delphi participants were asked to rate the potential items on a 9-point scale for level of importance (Part A), level of priority of action (Part B) and level of acceptability (Part C). The mean, standard deviation (SD) and I-CVI of each item were calculated. Clinical indicators with mean ≥ 7, I-CVI ≥ 0.78 were considered to have a good degree of agreement, appropriateness and relevance and were deemed acceptable for inclusion.

Participants completed a two-part online survey in Round 1, and three-part surveys in Rounds 2 and 3. Round 1, Part A included 44 clinical indicators. On completion of Round 3, 36 items remained. Care pathways in response to acute deterioration (n = 20) were included in Part B. After Round 3, 17 care pathways remained. There was agreement in Part C that communication aides, education and mentor programmes were necessary as viable strategies to support sustained adoption.

Detecting the early warning signs of acute deterioration will have significant outcomes for residents, staff and health care services.