‘They don’t know my body’: health consumer recognition and escalation of acute deterioration – a systematic review

Context Health consumer escalation of acute deterioration response systems are now widely available to help facilitate early recognition and response to acute deterioration in hospitals. Yet, a systematic synthesis of the literature on the signs and symptoms that health consumers consider representative of acute deterioration and the reasons for escalation has not been conducted.

Aims (1) To identify the signs and symptoms that health consumers recognise as indicative of acute deterioration, and (2) describe the reasons that health consumers activate acute deterioration response systems in hospitals.

Methods A systematic review was undertaken, informed by the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) statement and checklist. Five databases (Ovid Medline, Ovid Emcare, CINAHL Complete, Scopus and ProQuest Dissertations and Theses Global Database; January 2015–April 2025; English language) and Google Scholar were searched using a registered search strategy. Screening was undertaken in Covidence with all study designs that met the inclusion criteria included. The MMAT (Mixed-Methods Appraisal Tool) was applied to evaluate study quality. A convergent integrative synthesis was undertaken, incorporating thematic analysis.

Results From 947 unique titles/abstracts and 27 full-text articles, 14 studies met the inclusion criteria. Health consumers can identify a variety of physiological, cognitive, behavioural and functional changes indicative of acute deterioration. Health consumers activate acute deterioration response systems for four reasons: (1) reassurance, (2) reassessment, (3) re-establishing control and (4) recognition and respect.

Conclusions Health consumers’ ability to recognise acute deterioration varies, from clear, specific signs and symptoms to a non-specific sense that something is wrong. Health consumers activate acute deterioration response systems for multiple reasons.

PROSPERO registration number CRD420251013545.