Between the Flags uses the analogy of Surf Life Saving Australia’s lifeguards and lifesavers, who mark out safe zones on the beach, observe swimmers closely, prevent them from getting into danger and help them if anything goes wrong.

In a hospital setting, the lifeguards are frontline clinical staff who know when a patient is ‘between the flags’, by observing vital signs and clinical condition.

“Between the Flags is currently being implemented in health facilities in the Greater Western AHS,” said Lynda McKenzie, Project Officer for Early Detection and Management of Deteriorating Patients.

“The program was developed to enhance the early

recognition and management of patients who are clinically

deteriorating.”

Between the Flags will be implemented in 48 facilities in the Greater Western AHS. It will involve training for all staff involved in the care and management of patients.

A redesigned observation chart will be standardised across all NSW acute inpatient facilities to facilitate the recognition of vital signs of patient deterioration.

“The observation chart will make it easier for health professionals to monitor and recognise vital signs, such as breathing rate, heart rate, blood pressure and temperature. The charts will have coloured zones – yellow and red. The yellow section will recognise early warning signs that will require a clinical review, while the red will alert the doctor or nurse to a rapid response.”

“In the Greater Western Area we have been refining our local emergency response protocols to incorporate this new system,” Ms McKenzie said.

Between the Flags was developed by the Clinical Excellence Commission to help prevent unexpected deaths and reduce the risk of other adverse events.

The program is a major initiative of the NSW Government’s Caring Together: The Health Action Plan for NSW. It has been developed in line with a recommendation from the Garling Report and is strongly supported by doctors and nurses across the NSW public health system.

The use of the symbolism of the red and yellow flags was approved by Surf Life Saving Australia.