Cardiac Core —
Training activity: 20

Details

Recognise, intervene and monitor a deteriorating patient

Type

Entrustable training activity (ETA)

Evidence requirements

Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion. ​

Reflection at multiple timepoints on the trainee learning journey for this activity.

Reflective practice guidance

The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.

Before action

What does success look like?

• Identify what is expected of you in relation to recognising, intervening, and monitoring a deteriorating patient.
• Consider how the learning outcomes apply, specifically in relation to interpreting physiological data and demonstrating effective communication during a critical event, adhering to patient safety principles.
• What does appropriate identification of signs of deterioration and correct initial intervention (within your scope of practice) look like for this activity?
• Discuss with your training officer to gain clarity on expectations for identifying specific vital signs or parameters to focus on, the appropriate initial interventions/steps for escalation within your role, and monitoring protocols.

What is your prior experience of this activity?

• Think about what you already know about the common signs and causes of patient deterioration (e.g., changes in ECG or haemodynamic data) and initial actions such as calling for help or basic monitoring.
• Consider possible challenges you might face during the activity, such as recognising subtle changes, acting quickly under pressure, or communicating clearly in an emergency situation, and think about how you might plan to handle them.
• Recognise the scope of your own practice for this activity i.e. know when you will need to seek advice or help, and from whom when performing initial interventions or when the patient status requires escalation (e.g., to a senior clinician or emergency team).
• Acknowledge how you feel about undertaking this critical training activity involving patient monitoring and intervention.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop related to patient assessment, identifying early warning signs, or communicating effectively during an emergency.
• Identify specific insights you hope to gain regarding the typical progression of deterioration for certain cardiac conditions or the importance of specific monitoring parameters (e.g., haemodynamic monitoring).

What additional considerations do you need to make?

• Consult actions identified following previous experience of clinical emergencies or patient safety scenarios.
• Identify important information you need to consider before embarking on the activity, such as specific emergency protocols in your department, the location of emergency equipment (e.g., resuscitation equipment), or any patient-specific limitations or resuscitation plans.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst assessing the patient or initiating monitoring/intervention?
• Are you encountering situations such as:
  • Rapid deterioration requiring simultaneous assessment (e.g., ABCDE approach) and action under intense pressure?
  • Ambiguous or conflicting clinical signs e.g., low blood pressure but normal heart rate that make identifying the primary cause of deterioration difficult?
  • A breakdown in team communication during the crisis, making coordination challenging?

How are you reacting to the unexpected development?

• How is this impacting your actions? For example, are you responding to the situation appropriately? Are you adapting or changing your prioritisation of interventions or escalation steps in the moment?
• Consider the steps you are taking in the moment, such as:
  • Immediately calling for appropriate help (e.g., emergency medical team) and providing a concise initial summary of the situation?
  • Focusing strictly on primary survey actions (e.g., airway and breathing) while escalating concerns to senior staff?
  • Seeking immediate advice regarding the interpretation of complex or rapidly changing physiological data?
• How are you feeling in that moment? For instance, are you finding it difficult to prioritise tasks under acute stress? Is it affecting your confidence in recognizing the signs of deterioration?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully coordinating the initial response and escalating appropriately? Or are you needing support because the required action is beyond your current clinical authority?
• What are you learning as a result of the unexpected development? For example, are you mastering stress management techniques in a clinical emergency? Or gaining insight into the structured approach (e.g., ABCDE) for managing rapidly deteriorating patients?

On action

What happened?

• Begin by summarising the key points of the experience, detailing the signs and symptoms that led you to recognise that the patient was deteriorating.
• Consider specific events, actions, or interactions which felt important, such as the initial assessment you performed, any interventions you initiated or assisted with, and how you subsequently monitored the patient’s response.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, prioritising actions or coordinating with other healthcare professionals during the crisis. How did you feel during this experience?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding your ability to recognise, intervene for, and monitor a deteriorating patient. What strengths did you demonstrate e.g., clinical assessment skills in an acute situation? What skills and/or knowledge gaps were evident e.g., confidence in performing specific interventions or coordinating actions?
• Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved?
• Identify any challenges you experienced, such as acting quickly, prioritising actions, or coordinating with other healthcare professionals, and how you reacted to these. How does this activity contribute to your skills in managing medical emergencies?
• Identify anything significant about the activity, such as needing to seek advice or clarification on specific intervention protocols or monitoring parameters.
• Acknowledge any changes in your own feelings now you are looking back on the experience.

What will you take from the experience moving forward?

• Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt, including utilising training, simulations, or mentorship.
• What will you do differently next time you approach a similar situation to enhance your patient recognition, intervention, or monitoring skills? Has anything changed in terms of what you would do if you were faced with a similar situation again?
• Do you need to practise any aspect of the activity further, such as refining your skills in prioritising actions or clinical assessment in critical areas?

Beyond action

Have you revisited the experiences?

• Have you reviewed your actions from your previous reflections for this activity? What specific actions did you previously identify you would need to take to improve your practice related to early recognition, appropriate intervention, and clear escalation?
• Have you completed these previously identified actions? For example, if you planned to review procedures for checking resuscitation equipment or consult resources on haemodynamic data interpretation in critical states, how did completing this action impact your subsequent performance?
• Engage in professional storytelling with peers, near peers, or colleagues about critical interventions or challenging patient deterioration scenarios. How have observations from the coronary care unit (CCU) ward round influenced your understanding of the prognosis and management of acute cardiac presentations?

How have these experiences impacted upon current practice?

• Consider how the accumulated learning from performing or reflecting on managing a deteriorating patient will support you in preparing for observed ‘in-person’ assessments for the module, such as a DOPS titled ‘Perform a check of resuscitation equipment’ or Case-Based Discussions requiring application of physiological data interpretation in an emergency setting.
• How has your practice in employing specialist knowledge to deliver a safe and high-quality service developed and evolved over time? For example, how does the ability to recognise deterioration influence your prioritisation and communication across all diagnostic and interventional tasks?
• What transferable skills e.g., crisis management, systematic assessment or professional conduct did you develop through this activity, and how will this foundational understanding of patient safety help you contribute to service improvement and critical care innovation in the future?

Relevant learning outcomes

#	Outcome
# 6	Outcome Interpret haemodynamic data for patients presenting to the cardiac cath lab with a range of conditions, recognising the role of these procedures within the patient pathway, limitations of diagnostics and troubleshooting where required.
# 8	Outcome Demonstrate the ability to communicate effectively with patients, carers and the wider multidisciplinary team.