Home care provider’s ‘soft signs’ system ‘significantly reduces’ hospital admissions

Care workers use 'soft signs' list to spot deterioration and alert nurses
Patient deterioration

Care workers use 'soft signs' list to spot deterioration and alert nurses

Care workers use a list of 120 signs of deterioration such as loss of appetite
Picture: Alamy

Creating a system identifying the ‘soft signs’ of patient deterioration in home care has helped lower hospital admissions, a care provider claims.

Interserve Healthcare, which cares for people with brain and spinal injuries, genetic and motor neurone disease, has created a system to help care workers flag signs of deterioration. Care workers use a list of 120 signs, such as loss of appetite, to create a summary of behavioural or physical changes they observe in the individual.

Interserve Healthcare’s chief nurse Andy Cook said the company reviewed cases where clients had been admitted to hospital after developing a health problem. It was found that notes by care workers had indicated health issues were developing. This was the impetus for the soft signs system.

Nurses notified

If a change is spotted, the care worker notifies nurses that a patient’s condition may have deteriorated and so may require intervention.

Mr Cook presented the results of the company’s soft signs system at the HSJ Patient Safety Congress in Manchester this week.

He told his audience: ‘For example, if the client is someone who sleeps solidly and has a regular sleep pattern, it would make sense to use a sudden change in sleep pattern as a soft sign for that client.

‘The selection is based on individual assessment based on the experience of most importantly the client first, the family, and then our care staff.’

Proactive approach

‘The registered nurses at branch – or in the locality – understand that when a soft sign is called in it could herald a wider problem,’ Mr Cook said.

‘They respond proactively on the basis that a more serious issue needs to be excluded rather than the soft sign needing to be proven.’

He said spotting signs that a patient is deteriorating at home was challenging because of a lack of access to systems such as the national early warning score (NEWS) to identify worsening conditions.

Deterioration can go unnoticed at home

‘There are usually no screens, no monitors, no near-patient testing and this makes the use of NEWS or NEWS2 as a framework for identifying deterioration almost impossible,’ he said.

However, Mr Cook said because the home is a challenging diagnostic environment it meant patients could develop problems that needed substantial intervention. 

‘Clients can often deteriorate slowly over several days and this can mean disease is more advanced when they exhibit more clinical signs,’ he said.

Examples of ‘soft signs’ of deterioration

  • Lack of interest in personal care
  • Lack of interest in getting out of bed or getting dressed
  • Change in presentation, being unshaved, unwashed
  • Becoming more dependent on others for care
  • A change in sleep patterns
  • Unresponsive to pain


Now the system has now been introduced in the company’s 17 branches and provided good results.

Reduced length of stay

Mr Cook said: ‘Our registered nurses review clients sooner and we’ve managed to divert about 25 admissions to hospital or significantly reduce the length of stay and complexity of treatment.

‘We’ve avoided the admission and sectioning of a patient with mental health problems on a number of occasions because subtle changes in mood and interaction now lead to early review by the mental health crisis team.’

Fellow conference speaker, Salisbury NHS Foundation Trust consultant nurse Maria Ford said soft signs may be useful in other care settings too.

‘As nurses we don’t pick up the early signs, such as a change in the patient’s behaviour,’ she said.

‘Soft signs are important. We need to bring in our physiotherapists and the family at that point, to get to know the patient and ask the family at the beginning of hospital admission: “What would make you worried about your relative?”’

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