High absenteeism among hospital staff should be anticipated if patients are admitted with either avian or pandemic influenza, particularly if specific antiviral preventative measures are not immediately available. Measures to maximize the safety of staff and their families would be important incentives to attend work. Education on realistic level of risk from avian and pandemic influenza, as well as the effectiveness of basic infection control procedures and personal protective equipment, would be useful in improving willingness to work.

Objective: In an effort to reduce waiting times and improve the performance of the clinical indicator waiting time relative to triage category, a rapid assessment team was implemented. Methods: The rapid assessment team consists of the rapid assessment team doctor and triage nurse. The rapid assessment team ensured, wherever possible, that patients were medically assessed prior to expiration of the waiting time appropriate to their National Triage Scale. Waiting time performance indicators, median waiting time and length of stay during the 3 months the rapid assessment team was operative were compared with the same period 1 year before. Results: During the 3 month period where the rapid assessment team was operative, 59.0% of patients (n = 5877) were seen within accepted time standards and the median waiting time was 32 min. This compared with 39.1% (n = 3901) and 50 min, respectively, in the same period 1 year before (P < 0.001). There was no significant difference in median length of stay (3.2 h for both, P = 0.18). Improvements in waiting times occurred in all triage categories except category 1. Due to a lack of resources and funds, the rapid assessment team was discontinued on 4 October 1997. Conclusions: The rapid assessment team reduces doctor waiting times. Departments considering implementing a rapid assessment team should ensure it is funded as a separate resource.

The second article on the use of track and trigger scoring (TTS) and National Early Warning Scoring Systems (NEWS 1 and 2) discusses how their use in relation to some patients can be too sensitive and in the case of others it merely detects late deterioration. This raises concerns that TTS and NEWS focus on a single set of observations at one point in time. They, therefore, ignore the observational trends by failing to compare the latest readings against previous sets of vital signs. It is therefore important that nurses do not rely solely on these tools, but use them in conjunction with their physiological knowledge and clinical assessment to identify deteriorating patients, as well as those who do not require unnecessary escalation of care.

Evidence suggests that the identification and response to the deteriorating patient continues to be an ongoing concern, despite the widespread use of track and trigger score (TTS) systems. This article discusses the variations in the parameters included in the different TTS systems in use across the NHS and their sensitivity. Clinical guidelines and physiological theory are used to appraise the parameters allocated in the National Early Warning Score (NEWS 1 and 2), highlighting potential limitations of the tool. The findings lead to the conclusion that registered nurses should not rely solely on NEWS, but should use it to support their clinical judgement.

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This article discusses the evidence in relation to preventable deaths and a reported culture of suboptimal care. It warns of the dangers of over-relying on track and trigger systems (TTS) in place of clinical judgement. The article explores cultural and behavioural factors, the effects of short staffing and inappropriate skill mix, which all increase the risk of human error. It emphasises a key message that registered nurses must reflect on the need to change their individual and team approaches to the recognition and assessment of the deteriorating patient.

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Objective Rapid sequence intubation (RSI) is a core critical care skill. Emergency medicine trainees are exposed to relatively low numbers of RSIs. We aimed to improve patient outcomes by implementing an RSI checklist, electronic learning and audit, in line with current best evidence. Methods Prospective observational study of RSIs performed in the EDs of two Queensland hospitals between January 2014 and December 2016. Data collected included: first‐pass success (FPS), predicted difficulty, indication for intubation, drugs used, positioning, number of attempts, checklist use and complications. Descriptive statistics and multivariable modelling were used to describe differences in FPS, and complications. Results Six hundred and fifty‐five patients underwent RSI with FPS of 86.6%. Complications were reported in 15.9%, mainly hypotension (10.9%) and desaturation (4.0%). FPS improved with bougie use (88.9% vs 73.0% without bougie, P < 0.001) and video‐laryngoscopy (88.2% vs 72.9% using standard laryngoscopy, P < 0.001). New desaturation was reduced with apnoeic oxygenation (2.0% vs 22.2%, P < 0.001), bougie use (2.8% vs 8.9%, P < 0.001), checklist use (2.3% vs 22.7%, P < 0.001) and achieving FPS (2.1% vs 16.3%, P < 0.001). Complications were reduced with checklist use (13.3% vs 43.2%, P < 0.001) and apnoeic oxygenation use (3.9% vs 31.1%, P < 0.001). Logistic regression found checklist use was associated with reduced desaturation (OR 0.1, 95% CI 0.04–0.27) and the composite variable of any complication (OR 0.39, 95% CI 0.17–0.89). Conclusions Implementation of an evidence‐based care bundle and audit of practice has created a safe environment for trainees to learn the core critical care skill of RSI. In our setting, checklist use was associated with fewer complications.