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Improving recognition and treatment of deterioration: Incorporating patients’ worries & concerns in the assessment of acute illness – 18 April 2024

Delivered and presented by: Liz Tomlin – Head of Quality Improvement and Clinical Outcomes, Bradford Teaching Hospitals NHS Foundation Trust


There are very few routine and reliable mechanisms for patients, carers and families to escalate past the primary team when concerned about standard care not meeting their needs. Failing to escalate in a timely manner timely can have adverse effects to patient outcomes. It has been recognised that having reliable patient and family escalation systems is also a quality marker of patient centred care. NHS England’s Worry and Concern Task and Finish Group (a subgroup of the Acute Deterioration Board) have run a national improvement collaborative from April 2023 for 12 months. Bradford Teaching Hospitals NHS Foundation Trust has participated in this pilot to develop, test, implement and evaluate methods to incorporate patients’ views of their wellness/illness and worries and concerns in the assessment and recognition of acute illness and risk of deterioration.
Using a Quality Improvement approach, we adopted the Patient Wellness Questionnaire as a tool to measure patient reported wellness. We have conducted small tests of change across three different wards (surgical and medical). We have demonstrated that when used by qualified nursing staff, supported by strong leadership at a ward level, the PWQ is a reliable and useful tool to identify ‘soft signs’ of deterioration and supports nursing staff to escalate to the Critical Care Outreach Team for an independent review.


Liz is Head of Quality Improvement and Clinical Outcomes at Bradford Teaching Hospitals NHS Foundation Trust. Qualifying as a Registered Nurse in 1990 in adult nursing, Liz has worked in the acute clinical setting for over 16 years. In 2007, Liz joined the Trust and has spent over a decade working in patient safety research at the Bradford Institute of Health Research. Following an MSc in Health Sciences at the University of York, Liz successfully completed a PhD in 2018, funded by the Health Foundation, at the University of Leeds. Her thesis explored the mechanisms of change underpinning a specific quality improvement (QI) methodology: experienced based co-design. Liz has pursued her interests with Improvement Science and has experience in patient and public involvement and engagement in the healthcare setting. Liz is committed to delivering meaningful changes to improve the quality and safety of patient care and improving the work experience for staff.