by Catherine Harker, Kate Gatling.


Download the poster for this Quality Improvement


We made the decision to carry this project out in a clinical area that had been struggling with changes to leadership and changes to the specialty patients admitted to the ward.

We involved myself as I had strong professional working relationships with the ward, the clinical educator and some of the nurses.

Before the start of the project, we asked the library to perform a literature search around A-E assessment tools and we choose one to base our teaching handout on.

We collected baseline data from the ACRT database from ACRT calls that were made on the ward area and whether any of the patients had had an A-E assessment before the call was made.


S - We’re aiming to improve the incidence of documented

A- E assessments by 50% over a 3- month period.

M - Measuring by the data from the ACRT database. Auditing the calls information and seeing whether there was an improved incidence of health care professionals documenting an A-E assessment.

A - Attainable if staff engage with the teaching sessions and continue to use the A-E assessment.

R - Realistic- Above.

T - Timely- For 50% improvement in completed assessments is 3 months.


The stakeholders of the project were keen for this project to be led in this area due to their lack of access to education or support when caring for patients at risk of deterioration. It appeared initially that because of the high buy-in from the stakeholders there would be an increased probability of a positive result from the project.

We gave face 2 face teaching sessions about A-E assessments using a scenario-based example.

We also gave out an A-E assessment handout which staff took home from the teaching session to use as a refresher.


The initial results of the project are disappointing. Following the educational intervention, the documented incidence of an A-E assessment did improve, however these improvements were minimal. The improvement shown initially has failed to show longevity. An additional Audit has been completed 3-months following the cessation of any educational input showing 0% improvement in documented A-E assessments.

Lessons Learnt

We learnt that in order to implement a significant change, more change makers were required in the clinical area.

We had potentially failed to consider that due to the numerous changes these members of staff had experienced within a small-time frame there may be lack of engagement or motivation to change practice as they were already change-fatigued.

Next steps

Do another PDSA cycle, trialling a print-out laminated reminder on all computers to do the ABCDE assessment.