Training activity information
Details
Recognise unwell patients during routine tests and respond accordingly
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 signs of a deteriorating patient during tests and responding appropriately with methods of escalation.
- Consider how the learning outcomes apply, specifically concerning applying an Airway, Breathing, Circulation (ABC) approach and determining consciousness levels.
- Discuss with your training officer to gain clarity on specific ‘red flag’ indicators and escalation protocols.
What is your prior experience of this activity?
- Think about what you already know about patient assessment, physiological deterioration, and emergency response procedures.
- Consider possible challenges you might face during the activity, such as identifying subtle changes, remaining calm under pressure, or effectively escalating concerns, and think about how you might handle them.
- Recognise the scope of your own practice regarding managing unwell patients and know when you will need to seek advice or help, and from whom (e.g., senior emergency medical team).
- Acknowledge how you feel about embarking on this training activity, particularly concerning the responsibility of patient safety.
What do you anticipate you will learn from the experience?
- Consider specific skills you want to develop, such as rapid assessment of patient stability, confident decision-making in critical moments, or effective communication during escalation.
- Identify specific insights you hope to gain regarding the practical application of physiological deterioration protocols and immediate patient management.
What additional considerations do you need to make?
- Consult actions identified following previous experiences with patient deterioration or emergency scenarios.
- Identify important information you need to consider before embarking on the activity, such as the location of emergency equipment, team roles in a deteriorating patient situation, or relevant infection control protocols.
In action
Is anything unexpected occurring?
- Did you identify an unwell patient, and are you noticing anything surprising or different from what you anticipate in that recognition or subsequent response?
- Are you encountering situations such as:
- A rapid and unexpected deterioration of the patient during the routine test, e.g., sudden hypotension or tachyarrhythmia.
- Subtle haemodynamic shifts or ECG changes that may indicate a procedural complication but are difficult to definitively classify as an emergency.
How are you reacting to the unexpected development?
- How is this impacting your actions? For example, are you responding appropriately and promptly to the patient’s symptoms? Are you adapting your immediate actions or escalation plan?
- Consider the steps you are taking in the moment, such as:
- Immediately alerting the senior staff to a significant change in physiological parameters.
- Focusing strictly on primary survey actions while escalating concerns to senior staff.
- Initiating basic interventions within your scope, such as verifying monitoring connections or preparing emergency equipment.
- How are you feeling in that moment? For instance, are you finding it difficult to act quickly under pressure? Is it affecting your confidence in your ability to recognise and respond?
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 intervention is beyond your scope?
- Identify what you are learning as a result of the unexpected development. For example, are you mastering clear and urgent communication techniques during critical events, ensuring appropriate escalation?
On action
What happened?
- Summarise the key points of the experience of recognising an unwell patient during a routine test and your subsequent response.
- Consider specific events, actions, or interactions that felt important during the recognition and response, including your own feelings during the experience.
- Detail the specific signs or symptoms e.g., sudden onset of chest pain or hypotension that led you to recognise the deterioration and the initial actions taken e.g., applying the ABC approach or calling for help.
- Include any ‘reflect-in-action’ moments where you adapted to the patient’s deterioration or unexpected findings as they unfolded, and how you adjusted your immediate actions or escalation plan.
- Describe adapting the immediate response when a patient exhibited rapid deterioration e.g., requiring urgent escalation to the senior emergency medical team and maintaining focus on primary survey actions despite rising pressure.
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience of recognising and responding to an unwell patient.
- What strengths did you demonstrate in identifying signs of deterioration or in your emergency response, and what skills or knowledge gaps were evident e.g., quick assessment, escalation protocols?
- Evaluate your strength in applying the ABC approach versus a possible knowledge gap in local red flag criteria or escalation procedures.
- Compare this experience against previous engagements with similar activities. Were any previously identified actions for development achieved? Has your practice in recognising and responding to unwell patients improved?
- Identify any challenges you experienced e.g., rapid deterioration, difficulty in assessment, uncertainty and how you reacted to these. Did this affect your ability to deal with the situation? Were you able to overcome the challenges?
- Acknowledge any changes in your own feelings now that you are looking back on the experience.
- Identify anything significant about the activity, such as if you needed to seek urgent advice or clarification, or if you needed to escalate to ensure that you were working within your scope of practice.
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 learned, including from any feedback you have received regarding your ability to recognise and respond to unwell patients.
- What will you do differently next time you encounter an unwell patient during a routine test? Has anything changed in terms of your immediate response or escalation strategy? Do you need to practise any aspect of recognition or emergency response further?
- Plan to undertake specific simulation training focused on applying the red flag approach and ensuring rapid, concise communication with the senior emergency medical team during a crisis.
Beyond action
Have you revisited the experiences?
- Have you reviewed your actions from your previous reflections for this activity? Did you review your previous reflections on this critical activity, especially regarding your initial reactions, decision-making under pressure, and escalation pathways? Have you completed any identified actions for improvement related to your responsiveness or awareness?
- If you previously planned to review specific emergency protocols or red flag indicators, how did completing this review impact your subsequent performance when monitoring patient status?
- How have discussions with senior colleagues or multidisciplinary team members about managing acutely unwell patients further refined your understanding of appropriate responses and professional scope of practice in such situations? How has discussing previous critical incidents refined your ability to interpret real-time haemodynamic data or initiate immediate interventions?
How have these experiences impacted upon current practice?
- Consider how your learning will support you in preparing for the observed ‘in-person’ assessments for the module. How does this practical experience and ongoing reflection contribute to your ability to perform clinical assessments, ensuring recognition of the deteriorating patient and appropriate methods of escalation as outlined in your learning outcomes?
- Consider how your practice has developed and evolved over time. Has your vigilance for signs of patient deterioration e.g., changes in consciousness level, respiratory distress increased across all your clinical activities, making you more proactive in monitoring patients during procedures?
- What transferable skills did you develop through this activity? What specific physiological indicators or behavioural cues are you now more attuned to, which alert you to potential patient deterioration during a routine test?
- What continuing professional development or practical exposure do you seek to further strengthen your ability to recognise and respond to unwell patients, ensuring patient safety is always prioritised?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 1 |
Outcome
Identify the causes of common respiratory symptoms, including breathlessness (dyspnoea), wheezing, coughing and chest pain. |
| # 3 |
Outcome
Perform a clinical assessment of a patient with respiratory disease or a sleep condition ensuring recognition of the deteriorating patient and appropriate methods of escalation where appropriate. |
| # 4 |
Outcome
Demonstrate a patient centered approach to practice, considering communication with patients and relatives, the patient’s experience, quality of life and the wider social impact on the patient and their family. |
| # 5 |
Outcome
Interpret the results of a clinical assessment and communicate effectively with respiratory scientists and non-respiratory health care colleagues. |