Between the Flags


The aim of Between the Flags is to improve early recognition and response to clinical deterioration.


The Between the Flags system is designed to protect patients from deteriorating unnoticed and to ensure they receive appropriate care. It is a ‘safety net’ for patients who are cared for in NSW public hospitals and health care facilities.


The lack of recognition and management of patients who are clinically deteriorating is a significant issue not only in NSW but in hospitals around the world.

In 2010 the Clinical Excellence Commission (CEC) launched the Between the Flags (BTF) Program in response to this issue. The simple premise of BTF is that early recognition of deterioration can reduce harm to patients, and the earlier this happens the better. BTF has introduced a state-wide safety net by using standard vital sign observations to recognise deteriorating patients and establishing response systems in all NSW hospitals.

Since implementation, there has been a 35% reduction in cardiac arrests within NSW public hospitals and a significant positive shift in work culture. BTF has provided the foundations and support for other patient safety programs led by the CEC.

The BTF program addresses the Australian Commission on Safety and Quality in Health Care National Standard 9 - Recognising and Responding to Clinical Deterioration in Acute Health Care.



Key Dates

Pilot Sites

Implementation Sites


Since the Between the Flags system was introduced, there has been a decline of over 35% in the cardiac arrest rate in NSW hospitals. This translates into nearly 1000 fewer arrests than would have been expected.

Related Initiatives

Between the Flags has provided the foundation for other clinical improvement projects for NSW Health including the Sepsis Kills and REACH projects. Both projects relate to the early recognition of deterioration, with the Sepsis Kills project focusing on severe infection and the REACH project on activation of the Clinical Emergency Response Systems (CERS) by the patients and their family/personal carers.


Between the Flags Project Officer
02 9269 5500

Page Top | Added: 30 October 2013 | Last modified: 9 November 2015

Between the Flags Project Officer

02 9269 5500