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Currey J, Sprogis SK, Jones D, Considine Ao J. Improving the pre-medical emergency team: the case for a behavioural theoretical lens. AUST HEALTH REV 2024; 48:371-373. [PMID: 38574379 DOI: 10.1071/ah24041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 03/20/2024] [Indexed: 04/06/2024]
Abstract
There is mounting evidence that the pre-medical emergency team (pre-MET) of rapid response systems is underutilised in clinical practice due to suboptimal structures and processes and resource constraints. In this perspective article, we argue for examining the pre-MET through a 'Behaviour Change Wheel' lens to improve the pre-MET and maximise the associated patient safety benefits. Using pre-MET communication practices as an example, we illustrate the value of the COM-B model, where clinicians' 'capability', 'opportunity', and 'motivation' drive 'behaviour'. Optimising clinicians' behaviours and establishing failsafe rapid response systems is a complex undertaking; however, examining clinicians' behaviours through the COM-B model enables reframing barriers and facilitators to develop multifaceted and coordinated solutions that are behaviourally and theoretically based. The COM-B model is recommended to clinical governance leaders and health services researchers to explore the underlying causes of behaviour and successfully enact change in the design, implementation, and use of the pre-MET to improve patient safety.
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Affiliation(s)
- Judy Currey
- School of Nursing and Midwifery & Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, Vic. 3220, Australia
| | - Stephanie K Sprogis
- School of Nursing and Midwifery & Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, Vic. 3220, Australia
| | - Daryl Jones
- Department of Intensive Care, Austin Hospital, 145 Studley Road, Heidelberg, Vic. 3084, Australia; and School of Public Health and Preventive Medicine, Monash University, 533 St Kilda Road, Melbourne, Vic. 3004, Australia; and Department of Surgery, University of Melbourne, Parkville, Vic. 3010, Australia
| | - Julie Considine Ao
- School of Nursing and Midwifery & Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, Vic. 3220, Australia; and Centre for Quality and Patient Safety Research - Eastern Health Partnership, 2/5 Arnold Street, Box Hill, Vic. 3128, Australia
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Sprogis SK, Currey J, Jones D, Considine J. Clinicians' use and perceptions of the pre-medical emergency team tier of one rapid response system: A mixed-methods study. Aust Crit Care 2023; 36:1050-1058. [PMID: 36948918 DOI: 10.1016/j.aucc.2023.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 01/09/2023] [Accepted: 01/22/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND The pre-medical emergency team (pre-MET) tier of rapid response systems facilitates early recognition and treatment of deteriorating ward patients using ward-based clinicians before a MET review is needed. However, there is growing concern that the pre-MET tier is inconsistently used. OBJECTIVE This study aimed to explore clinicians' use of the pre-MET tier. METHODS A sequential mixed-methods design was used. Participants were clinicians (nurses, allied health, doctors) caring for patients on two wards of one Australian hospital. Observations and medical record audits were conducted to identify pre-MET events and examine clinicians' use of the pre-MET tier as per hospital policy. Clinician interviews expanded on understandings gained from observation data. Descriptive and thematic analyses were performed. RESULTS Observations identified 27 pre-MET events for 24 patients that involved 37 clinicians (nurses = 24, speech pathologist = 1, doctors = 12). Nurses initiated assessments or interventions for 92.6% (n = 25/27) of pre-MET events; however, only 51.9% (n = 14/27) of pre-MET events were escalated to doctors. Doctors attended pre-MET reviews for 64.3% (n = 9/14) of escalated pre-MET events. Median time between escalation of care and in-person pre-MET review was 30 min (interquartile range: 8-36). Policy-specified clinical documentation was partially completed for 35.7% (n = 5/14) of escalated pre-MET events. Thirty-two interviews with 29 clinicians (nurses = 18, physiotherapists = 4, doctors = 7) culminated in three themes: Early Deterioration on a Spectrum, A Safety Net, and Demands Versus Resources. CONCLUSIONS There were multiple gaps between pre-MET policy and clinicians' use of the pre-MET tier. To optimise use of the pre-MET tier, pre-MET policy must be critically reviewed and system-based barriers to recognising and responding to pre-MET deterioration addressed.
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Affiliation(s)
- Stephanie K Sprogis
- Deakin University, School of Nursing and Midwifery & Centre for Quality and Patient Safety in the Institute for Health Transformation, 1 Gheringhap St, Geelong, Victoria, 3220, Australia.
| | - Judy Currey
- Deakin University, School of Nursing and Midwifery & Centre for Quality and Patient Safety in the Institute for Health Transformation, 1 Gheringhap St, Geelong, Victoria, 3220, Australia.
| | - Daryl Jones
- Department of Intensive Care, Austin Hospital, 145 Studley Rd, Heidelberg, Victoria, 3084, Australia; School of Public Health and Preventive Medicine, Monash University, 533 St Kilda Road, Melbourne, Victoria, 3004, Australia; Department of Surgery, University of Melbourne, Parkville, Victoria, 3010, Australia.
| | - Julie Considine
- Deakin University, School of Nursing and Midwifery & Centre for Quality and Patient Safety in the Institute for Health Transformation, 1 Gheringhap St, Geelong, Victoria, 3220, Australia; Centre for Quality and Patient Safety Research - Eastern Health Partnership, 2/5 Arnold St, Box Hill, Victoria, 3128, Australia.
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Freeman-Sanderson A. Understanding the continuum of care in critical care: Not ABC but EBCD. Aust Crit Care 2023; 36:167-168. [PMID: 36842837 DOI: 10.1016/j.aucc.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
Affiliation(s)
- Amy Freeman-Sanderson
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia; Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia; Critical Care Division, The George Institute for Global Health, Newtown, NSW 2042, Australia; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, St Kilda Rd, VIC 3004, Australia.
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Exploration of Ward-Based Nurses' Perspectives on Their Preparedness to Recognize Clinical Deterioration: A Scoping Review. J Patient Saf 2023; 19:99-109. [PMID: 36729628 DOI: 10.1097/pts.0000000000001085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Despite initiatives in the early recognition of clinical deterioration, the incidence of failure to recognize clinical deterioration in patients continues to occur contributing to the ongoing rise of in-hospital mortality and morbidity. OBJECTIVE The aim of the study was to explore and appraise the research evidence that related to ward-based nurses' preparedness to recognize the clinically deteriorating patient. METHODS A scoping review was undertaken as this approach enabled the researchers to investigate the breadth of the available evidence through broad inclusion criteria. A comprehensive database search was conducted through the Cochrane Library; Cumulative Index to Nursing and Allied Health Literature; MEDLINE; ProQuest; PubMed; and Wiley Online Library. Each article was critically appraised and analyzed using a critical appraisal tool and thematic analysis, respectively. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews checklist. RESULTS Twelve primary sources of literature met the eligibility criteria. Through thematic analyses 6 primary themes were identified: implication of experience on preparedness; interprofessional and intraprofessional relationships; knowledge of calling criteria, process and procedures; requirement for a supportive system and culture; existence of hierarchy within healthcare impacting care; and clinical deterioration as an education opportunity. CONCLUSIONS This review identified central issues that impacted on ward-based nurses' preparedness. Further development of collaborative, supportive professional relationships across-and-within disciplines is needed. Effective use of clinical deterioration situations as educational opportunities would also assist nurses' preparedness through skill and knowledge development. However, more research evidence will be needed because of the limited data available on the topic.
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Newman D, Hofstee F, Bowen K, Massey D, Penman O, Aggar C. A qualitative study exploring clinicians’ attitudes toward responding to and escalating care of deteriorating patients. J Interprof Care 2022; 37:541-548. [DOI: 10.1080/13561820.2022.2104231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Deb Newman
- Northern New South Wales Local Health District, Australia
| | - Fran Hofstee
- Northern New South Wales Local Health District, Australia
| | - Karen Bowen
- Northern New South Wales Local Health District, Australia
| | - Deb Massey
- School of Health & Human Sciences Southern Cross Drive, Southern Cross University, Lismore, Australia
| | - Olivia Penman
- School of Health & Human Sciences Southern Cross Drive, Southern Cross University, Lismore, Australia
| | - Christina Aggar
- Northern New South Wales Local Health District, Australia
- School of Health & Human Sciences Southern Cross Drive, Southern Cross University, Lismore, Australia
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Clinicians' attitudes towards escalation and management of deteriorating patients: A cross-sectional study. Aust Crit Care 2022; 36:320-326. [PMID: 35490110 DOI: 10.1016/j.aucc.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/23/2022] [Accepted: 03/01/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Internationally, rapid response systems have been implemented to recognise and categorise hospital patients at risk of deterioration. Whilst rapid response systems have been implemented with a varying amount of success, there remains ongoing concern about the lack of improvement in the escalation, and management of the deteriorating patient. It also remains unclear why some clinicians fail to escalate concerns for the deteriorating patient. OBJECTIVE The objective of this study was to explore clinicians' attitudes towards the escalation, and management of the deteriorating patient. METHODS A cross-sectional online survey of conveniently sampled clinicians from the acute care sector in a regional health district in Australia was conducted. The Clinicians' Attitudes towards Responding and Escalating care of Deteriorating patients scale, was used to explore attitudes towards the escalation and management of the deteriorating patient. RESULTS Survey responses were received from medical officers (n = 43), nurses (n = 677), allied health clinicians (n = 60), and students (n = 57). Years of experience was significantly associated with more confidence responding to deteriorating patients (p < .001) and significantly less fears about escalating care (p < .001). Nurses (M = 4.16, SD = .57) and students (M = 4.11, SD = .55) in general had significantly greater positive beliefs that the rapid response system would support them to respond to the deteriorating patient than allied health (M = 3.67, SD = .64) and medical (M = 3.87, SD = .54) clinicians, whilst nurses and medical clinicians had significantly less fear about escalating care and greater confidence in responding to deteriorating patients than allied health clinicians and healthcare students (p < .001). CONCLUSION Nurses and medical officers have less fear to escalate care and greater confidence responding to the deteriorating patient than allied health clinicians and students. Whilst the majority of participants had positive perceptions towards the rapid response system, those with less experience lacked the confidence to escalate care and respond to the deteriorating patient.
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Nature and characteristics of orthopaedic medical emergency team (MET) events. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sawicki JG, Tower D, Vukin E, Workman JK, Stoddard GJ, Burch M, Bracken DR, Hall B, Henricksen JW. Association Between Rapid Response Algorithms and Clinical Outcomes of Hospitalized Children. Hosp Pediatr 2021; 11:1385-1394. [PMID: 34849928 DOI: 10.1542/hpeds.2020-005603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To evaluate whether the implementation of clinical pathways, known as pediatric rapid response algorithms, within an existing rapid response system was associated with an improvement in clinical outcomes of hospitalized children. METHODS We retrospectively identified patients admitted to the PICU as unplanned transfers from the general medical and surgical floors at a single, freestanding children's hospital between July 1, 2017, and January 31, 2020. We examined the impact of the algorithms on the rate of critical deterioration events. We used multivariable Poisson regression and an interrupted time series analysis to measure 2 possible types of change: an immediate implementation effect and an outcome trajectory over time. RESULTS We identified 892 patients (median age: 4 [interquartile range: 1-12] years): 615 in the preimplementation group, and 277 in the postimplementation group. Algorithm implementation was not associated with an immediate change in the rate of critical deterioration events but was associated with a downward rate trajectory over time and a postimplementation trajectory that was significantly less than the preimplementation trajectory (trajectory difference of -0.28 events per 1000 non-ICU patient days per month; 95% confidence interval -0.40 to -0.16; P < .001). CONCLUSIONS Algorithm implementation was associated with a decrease in the rate of critical deterioration events. Because of the study's observational nature, this association may have been driven by unmeasured confounding factors and the chosen implementation point. Nevertheless, the results are a promising start for future research into how clinical pathways within a rapid response system can improve care of hospitalized patients.
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Affiliation(s)
| | | | | | - Jennifer K Workman
- Departments of Pediatrics
- Critical Care, Primary Children's Hospital, Salt Lake City, Utah
| | - Gregory J Stoddard
- Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Mary Burch
- Intermountain Healthcare, Salt Lake City, Utah
| | | | - Brooke Hall
- Intermountain Healthcare, Salt Lake City, Utah
| | - Jared W Henricksen
- Departments of Pediatrics
- Critical Care, Primary Children's Hospital, Salt Lake City, Utah
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Byrne G, Ennis S, Barnes AM, Morrison P, Connors S, Quirke MB. Triggers and Interventions of Patients Who Require Medical Emergency Team Reviews: A Cross-Sectional Analysis of Single Versus Multiple Reviews. Crit Care Nurse 2021; 41:e1-e10. [PMID: 34333613 DOI: 10.4037/ccn2021407] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Medical emergency teams constitute part of the escalation protocol of early warning systems in many hospitals. The literature indicates that medical emergency teams may reduce hospital mortality and cardiac arrest. A greater understanding of pathways of patients who experience multiple medical emergency team reviews will inform clinical decision-making. OBJECTIVES To explore differences between patients who require a single medical emergency team review and those who require multiple reviews, and to identify any differences between patients who were reviewed only once during admission and patients who required multiple reviews. METHODS Data for this retrospective cross-sectional review, including demographic data, call triggers, outcomes, and interventions, were routinely collected from January 2013 through December 2015. The study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) collaborative's cross-sectional studies checklist (version 4). RESULTS Of 54 787 admitted patients, 1274 (2%) required a call to a medical emergency team; of those, 260 patients (20%) needed multiple calls. Patients requiring multiple calls demonstrated higher mortality (odds ratio, 1.49 [95% CI, 1.12-1.98]). A logistic regression model identified surgical patients and those receiving antibiotics and respiratory interventions at the first medical emergency team review as being more likely to require multiple reviews. Patients transferred to a higher level of care after the first review were less likely to require another review. CONCLUSIONS Patients requiring multiple medical emergency team reviews have higher mortality. Surgical patients have a higher risk of requiring multiple reviews. Hospitals need to include more details on surgical patients when auditing medical emergency team activation.
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Affiliation(s)
- Gobnait Byrne
- Gobnait Byrne is Director, Trinity Centre for Practice and Health-care Innovation, and an assistant professor, School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Shauna Ennis
- Shauna Ennis is Head of Learning and Development, Tallaght University Hospital, Dublin, Ireland
| | - Anne Marie Barnes
- Anne Marie Barnes is the Emergency Response System Coordinator, Tallaght University Hospital
| | - Patricia Morrison
- Patricia Morrison is the Assistant Director of Nursing and Lead Assistant Director of Nursing for the Perioperative Directorate, Tallaght University Hospital
| | - Siobhan Connors
- Siobhan Connors is a critical care outreach nurse, Tallaght University Hospital
| | - Mary B Quirke
- Mary B. Quirke is a research fellow, Trinity Centre for Practice and Healthcare Innovation, School of Nursing and Midwifery, Trinity College Dublin
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Sprogis SK, Currey J, Jones D, Considine J. Use of the pre-medical emergency team tier of rapid response systems: A scoping Review. Intensive Crit Care Nurs 2021; 65:103041. [PMID: 33795182 DOI: 10.1016/j.iccn.2021.103041] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this review was to explore use of the pre-Medical Emergency Team (pre-MET) tier of Rapid Response Systems to recognise and respond to adult ward patients experiencing early clinical deterioration. METHODS A scoping review of studies published in English reporting on use of a pre-MET tier in adult ward patients was conducted. Three databases were searched (Medline, CINAHL, EMBASE) for studies published between January 1995 and September 2020. Two researchers independently performed screening and quality assessments. Findings were synthesised thematically. Reporting of the review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. RESULTS Six of 1669 studies were included in this review. All were single-site studies of single-parameter Rapid Response Systems in Australian hospitals. Five were quantitative studies; one had a qualitative design. Studies fulfilled 50-100% of quality criteria. Two themes were constructed: Afferent processes - Recognising and escalating pre-MET events; and Efferent processes - Pre-MET reviews and associated interventions. There was disparity between clinical practice and pre-MET escalation protocols, and reports of nurse-initiated management of early deterioration. Prospective methods and exploration of multidisciplinary perspectives were notable research gaps. CONCLUSION Use of the pre-MET tier of Rapid Response Systems is under-researched. Further research is needed to understand barriers and facilitators influencing use of pre-MET strategies to address patient deterioration.
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Affiliation(s)
- Stephanie K Sprogis
- Deakin University: School of Nursing and Midwifery & Centre for Quality and Patient Safety in the Institute for Health Transformation, 1 Gheringhap St, Geelong, Victoria 3220, Australia. https://twitter.com/@Steph_Sprogis
| | - Judy Currey
- Deakin University: School of Nursing and Midwifery & Centre for Quality and Patient Safety in the Institute for Health Transformation, 1 Gheringhap St, Geelong, Victoria 3220, Australia; Deakin University: Deakin Learning Futures, Office of the Deputy Vice Chancellor (Education), 1 Gheringhap St, Geelong, Victoria 3220, Australia. https://twitter.com/@Judy_Currey
| | - Daryl Jones
- Department of Intensive Care, Austin Hospital, 145 Studley Rd, Heidelberg, Victoria, 3084, Australia; School of Public Health and Preventive Medicine, Monash University, Wellington Rd, Clayton, Victoria 3800, Australia; Department of Surgery, University of Melbourne, Parkville, Victoria 3010, Australia. https://twitter.com/@jones_daza
| | - Julie Considine
- Deakin University: School of Nursing and Midwifery & Centre for Quality and Patient Safety in the Institute for Health Transformation, 1 Gheringhap St, Geelong, Victoria 3220, Australia; Centre for Quality and Patient Safety Research - Eastern Health Partnership, 2/5 Arnold St, Box Hill, Victoria 3128, Australia. https://twitter.com/@Julie_Considine
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Sprogis SK, Currey J, Jones D, Considine J. Understanding the pre-medical emergency team tier of a mature rapid response system: A content analysis of guidance documents. Aust Crit Care 2021; 34:427-434. [PMID: 33685780 DOI: 10.1016/j.aucc.2020.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/10/2020] [Accepted: 12/13/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The pre-medical emergency team (pre-MET) tier of rapid response systems (RRSs) includes extended activation criteria to identify earlier clinical deterioration and a ward-based patient review that is undertaken by the affected patient's admitting team or covering doctors. There is limited understanding of the structure and processes of the pre-MET RRS tier that are expected to guide clinicians' actions and subsequent patient safety outcomes. OBJECTIVE The aim of the study was to describe the structure and processes of the pre-MET RRS tier in one acute care setting. METHODS An exploratory descriptive design involving document analysis was used. Guidance documents (policies, procedures, guidelines, charts, educational materials) were obtained from one health service with a mature, multitiered RRS in Melbourne, Australia. Documents were analysed using content analysis. Concept- and data-driven approaches were used to construct a coding frame. RESULTS Nineteen guidance documents supporting the pre-MET RRS tier on general wards were analysed. The coding frame consisted of seven main categories: Defining the Pre-MET RRS Tier, Essential Resources for Operationalisation, Recognising Pre-MET Events, Pathways for Activation, Exceptions to the Rule, Clinician Responses to Pre-MET Events, and Recording Pre-MET Events. The structures and processes of the pre-MET RRS tier were largely consistent with national guidelines, but there were internal inconsistencies in pre-MET activation criteria and unclear recommendations for modifying criteria. Pathways for activating the pre-MET RRS tier were complex and involved many steps, including validation processes before escalation of care to doctors. Responses to pre-MET events were seldom aligned to specific clinician types or groups, with nurses and allied health clinicians being under-represented. CONCLUSIONS We identified opportunities to improve guidance documents supporting the pre-MET RRS tier that may assist other health services engaged in planning or evaluating pre-MET strategies. Further research is needed to understand clinicians' use of the pre-MET RRS tier to inform targeted strategies to optimise its design and implementation.
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Affiliation(s)
- Stephanie K Sprogis
- Deakin University: School of Nursing and Midwifery & Institute for Health Transformation, 1 Gheringhap St, Geelong, Victoria, 3220, Australia.
| | - Judy Currey
- Deakin University: School of Nursing and Midwifery & Institute for Health Transformation, 1 Gheringhap St, Geelong, Victoria, 3220, Australia; Deakin University: Centre for Quality and Patient Safety Research, 1 Gheringhap St, Geelong, Victoria, 3220, Australia; Deakin University: Deakin Learning Futures, Office of the Deputy Vice Chancellor (Education), 1 Gheringhap St, Geelong, Victoria, 3220, Australia.
| | - Daryl Jones
- Department of Intensive Care, Austin Hospital, 145 Studley Rd, Heidelberg, Victoria, 3084, Australia; School of Public Health and Preventive Medicine, Monash University, Wellington Rd, Clayton, Victoria, 3800, Australia; Department of Surgery, University of Melbourne, Parkville, Victoria, 3010, Australia.
| | - Julie Considine
- Deakin University: School of Nursing and Midwifery & Institute for Health Transformation, 1 Gheringhap St, Geelong, Victoria, 3220, Australia; Deakin University: Centre for Quality and Patient Safety Research, 1 Gheringhap St, Geelong, Victoria, 3220, Australia; Centre for Quality and Patient Safety Research - Eastern Health Partnership, 2/5 Arnold St, Box Hill, Victoria, 3128, Australia.
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Ede J, Petrinic T, Westgate V, Darbyshire J, Endacott R, Watkinson PJ. Human factors in escalating acute ward care: a qualitative evidence synthesis. BMJ Open Qual 2021; 10:bmjoq-2020-001145. [PMID: 33637554 PMCID: PMC7919590 DOI: 10.1136/bmjoq-2020-001145] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 01/07/2021] [Accepted: 02/04/2021] [Indexed: 11/07/2022] Open
Abstract
Background Identifying how human factors affect clinical staff recognition and managment of the deteriorating ward patient may inform process improvements. We systematically reviewed the literature to identify (1) how human factors affect ward care escalation (2) gaps in the current literature and (3) critique literature methodologies. Methods We undertook a Qualitative Evidence Synthesis of care escalation studies. We searched MEDLINE, EMBASE and CINHAL from inception to September 2019. We used the Critical Appraisal Skills Programme and the Grading of Recommendations Assessment-Development and Evaluation and Confidence in Evidence from Reviews of Qualitative Research tool to assess study quality. Results Our search identified 24 studies meeting the inclusion criteria. Confidence in findings was moderate (20 studies) to high (4 studies). In 16 studies, the ability to recognise changes in the patient’s condition (soft signals), including skin colour/temperature, respiratory pattern, blood loss, personality change, patient complaint and fatigue, improved the ability to escalate patients. Soft signals were detected through patient assessment (looking/listening/feeling) and not Early Warning Scores (eight studies). In contrast, 13 studies found a high workload and low staffing levels reduced staff’s ability to detect patient deterioration and escalate care. In eight studies quantifiable deterioration evidence (Early Warning Scores) facilitated escalation communication, particularly when referrer/referee were unfamiliar. Conversely, escalating concerning non-triggering patients was challenging but achieved by some clinical staff (three studies). Team decision making facilitated the clinical escalation (six studies). Conclusions Early Warning Scores have clinical benefits but can sometimes impede escalation in patients not meeting the threshold. Staff use other factors (soft signals) not captured in Early Warning Scores to escalate care. The literature supports strategies that improve the escalation process such as good patient assessment skills. PROSPERO registration number CRD42018104745.
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Affiliation(s)
- Jody Ede
- Adult Intensive Care Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK .,Plymouth University, Plymouth, UK
| | - Tatjana Petrinic
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Verity Westgate
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Julie Darbyshire
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Ruth Endacott
- Plymouth University, Plymouth, UK.,School of Nursing & Midwifery, Monash University, Clayton, Victoria, Australia
| | - Peter J Watkinson
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
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Sok S, Sim H, Han B, Park SJ. Burnout and Related Factors of Nurses Caring for DNR Patients in Intensive Care Units, South Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8899. [PMID: 33266053 PMCID: PMC7729810 DOI: 10.3390/ijerph17238899] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/25/2020] [Accepted: 11/26/2020] [Indexed: 12/21/2022]
Abstract
This study examined the factors related to burnout, depression, job stress, and job satisfaction in intensive care unit (ICU) nurses caring for do not resuscitate (DNR) patients, as well as analyzed any differences. A cross-sectional descriptive design was employed. Study participants involved a total of 115 nurses caring for DNR patients in ICUs in South Korean hospitals. Measures involved a demographic form, Copenhagen Burnout Inventory (CBI), Center for Epidemiologic Studies Depression Scale, Nursing Job Stress Scale (Korean version), and Nursing Job Satisfaction Scale (Korean version). Data were collected from February to March 2017. The analyses illustrated a higher level of burnout, a slightly lower level of depression, a slightly lower level of nursing job stress, and a very slightly higher level of nursing job satisfaction compared with the median value of the score range for each scale. Burnout had a significant, positive relationship with depression and nursing job stress, and depression had a significant, positive relationship with nursing job stress. This study illuminates preliminary evidence that ICU nurses who are caring for DNR patients have a higher level of burnout compared with the median value of the score range in the CBI (Korean version). Burnout, depression, job stress, and job satisfaction were interrelated in ICU nurses.
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Affiliation(s)
- Sohyune Sok
- College of Nursing Science, Kyung Hee University, Seoul 02447, Korea
| | - Hyebeen Sim
- Department of Nursing, Graduate School, Kyung Hee University, Seoul 02447, Korea; (H.S.); (B.H.); (S.J.P.)
| | - Bokhee Han
- Department of Nursing, Graduate School, Kyung Hee University, Seoul 02447, Korea; (H.S.); (B.H.); (S.J.P.)
| | - Se Joung Park
- Department of Nursing, Graduate School, Kyung Hee University, Seoul 02447, Korea; (H.S.); (B.H.); (S.J.P.)
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Chua WL, Tee A, Hassan NB, Jones D, Tam WWS, Liaw SY. The development and psychometric evaluation of the Clinicians' Attitudes towards Responding and Escalating care of Deteriorating patients scale. Aust Crit Care 2020; 34:340-349. [PMID: 33250402 DOI: 10.1016/j.aucc.2020.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/14/2020] [Accepted: 08/31/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Validated measures of ward nurses' safety cultures in relation to escalations of care in deteriorating patients are lacking. OBJECTIVES This study aimed to develop and evaluate the psychometric properties of the Clinicians' Attitudes towards Responding and Escalating care of Deteriorating patients (CARED) scale for use among ward nurses. METHODS The study was conducted in two phases: scale development and psychometric evaluation. The scale items were developed based on a systematic literature review, informant interviews, and expert reviews (n = 15). The reliability and validity of the scale were examined by administering the scale to 617 registered nurses with retest evaluations (n = 60). The factor structure of the CARED scale was examined in a split-half analysis with exploratory and confirmatory factor analyses. The internal consistency, test-retest reliability, convergent validity, and known-group validity of the scale were also analysed. RESULTS A high overall content validity index of 0.95 was obtained from the validations of 15 international experts from seven countries. A three-factor solution was identified from the final 22 items: 'beliefs about rapid response system', 'fears about escalating care', and 'perceived confidence in responding to deteriorating patients'. The internal consistency reliability of the scale was supported with a good Cronbach's alpha value of 0.86 and a Spearman-Brown split-half coefficient of 0.87. An excellent test-retest reliability was demonstrated, with an intraclass correlation coefficient of 0.92. The convergent validity of the scale was supported with an existing validated scale. The CARED scale also demonstrated abilities to discriminate differences among the sample characteristics. CONCLUSIONS The final 22-item CARED scale was tested to be a reliable and valid scale in the Singaporean setting. The scale may be used in other settings to review hospitals' rapid response systems and to identify strategies to support ward nurses in the process of escalating care in deteriorating ward patients.
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Affiliation(s)
- Wei Ling Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Block MD11, Level 2, 10 Medical Drive, Singapore, 117597.
| | - Augustine Tee
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, 2 Simei Street 3, Singapore, 529889
| | - Norasyikin Binte Hassan
- Nursing Education and Research, Changi General Hospital, 2 Simei Street 3, Singapore, 529889
| | - Daryl Jones
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, 2 Simei Street 3, Singapore, 529889; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia; Department of Intensive Care Unit, Austin Hospital, 145 Studley Road PO Box 5555, Heidelberg, Victoria, Australia, 3084
| | - Wilson Wai San Tam
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Block MD11, Level 2, 10 Medical Drive, Singapore, 117597
| | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Block MD11, Level 2, 10 Medical Drive, Singapore, 117597
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Azimirad M, Magnusson C, Wiseman A, Selander T, Parviainen I, Turunen H. Nurses’ ability to timely activate rapid response systems for deteriorating patients: A comparative case scenario study between Finnish and British nurses. Intensive Crit Care Nurs 2020; 60:102871. [DOI: 10.1016/j.iccn.2020.102871] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 03/16/2020] [Accepted: 04/05/2020] [Indexed: 10/23/2022]
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16
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Flenady T, Dwyer T, Sobolewska A, Lagadec DL, Connor J, Kahl J, Signal T, Browne M. Developing a sociocultural framework of compliance: an exploration of factors related to the use of early warning systems among acute care clinicians. BMC Health Serv Res 2020; 20:736. [PMID: 32782002 PMCID: PMC7422559 DOI: 10.1186/s12913-020-05615-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 08/02/2020] [Indexed: 11/10/2022] Open
Abstract
Background Early warning systems (EWS) are most effective when clinicians monitor patients’ vital signs and comply with the recommended escalation of care protocols once deterioration is recognised. Objectives To explore sociocultural factors influencing acute care clinicians’ compliance with an early warning system commonly used in Queensland public hospitals in Australia. Methods This interpretative qualitative study utilised inductive thematic analysis to analyse data collected from semi-structured interviews conducted with 30 acute care clinicians from Queensland, Australia. Results This study identified that individuals and teams approached compliance with EWS in the context of 1) the use of EWS for patient monitoring; and 2) the use of EWS for the escalation of patient care. Individual and team compliance with monitoring and escalation processes is facilitated by intra and inter-professional factors such as acceptance and support, clear instruction, inter-disciplinary collaboration and good communication. Noncompliance with EWS can be attributed to intra and inter-professional hierarchy and poor communication. Conclusions The overarching organisational context including the hospital’s embedded quality improvement and administrative protocols (training, resources and staffing) impact hospital-wide culture and influence clinicians’ and teams’ compliance or non-compliance with early warning system’s monitoring and escalation processes. Successful adoption of EWS relies on effective and meaningful interactions among multidisciplinary staff.
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Affiliation(s)
- Tracy Flenady
- Central Queensland University, School of Nursing & Midwifery, Building 18, Bruce Highway, Rockhampton, 4702, Australia.
| | - Trudy Dwyer
- Central Queensland University, School of Nursing & Midwifery, Building 18, Bruce Highway, Rockhampton, 4702, Australia
| | - Agnieszka Sobolewska
- Central Queensland University, School of Nursing & Midwifery, Building 18, Bruce Highway, Rockhampton, 4702, Australia
| | - Danielle Le Lagadec
- Central Queensland University, School of Nursing & Midwifery, Building 18, Bruce Highway, Rockhampton, 4702, Australia
| | - Justine Connor
- Central Queensland University, School of Nursing & Midwifery, Building 18, Bruce Highway, Rockhampton, 4702, Australia
| | - Julie Kahl
- Central Queensland Hospital and Health Services, Canning Street, Rockhampton, 4701, Australia
| | - Tania Signal
- Central Queensland University, School of Nursing & Midwifery, Building 18, Bruce Highway, Rockhampton, 4702, Australia
| | - Matthew Browne
- Central Queensland University, School of Nursing & Midwifery, Building 18, Bruce Highway, Rockhampton, 4702, Australia
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Bingham G, Fossum M, Hughes L, Digby R, Bucknall T. The pre-Medical Emergency Team response: Nurses' decision-making escalating deterioration to treating teams using urgent review criteria. J Adv Nurs 2020. [PMID: 32432363 DOI: 10.1111/jan.14433] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 03/24/2020] [Accepted: 05/04/2020] [Indexed: 11/29/2022]
Abstract
AIM To describe nurses' decision-making, experiences and perceptions of escalating deteriorating patients to the treating medical team using urgent clinical review criteria. DESIGN A qualitative design comprising individual in-depth interviews with nurses from a major Australian metropolitan tertiary teaching hospital. METHOD A purposive sample of 30 Registered Nurses from nine surgical and medical wards were interviewed in April 2018 using semi-structured interviews. An inductive thematic analysis was conducted. RESULTS Identified themes included: detecting the deterioration; countering the problem; getting a response; and challenges faced in the process of escalation. Nurses reported an important awareness, sense of responsibility, and critical thinking to ensure the safe management and escalation of deteriorating patients. However, barriers to escalation necessitated individual workarounds and organizational structures to mitigate patient risk. CONCLUSION This study supports the importance of communication between clinical teams and recognizes that it is crucial to enable a fail-safe experience for patients and families. Recognition of disciplinary contributions to patients' goals of care is required to better understand and address the prevalence of deteriorating patients. Our study is among the first to explore the actual experience of nurses who articulate balancing uncertainty and managing complex team dynamics on wards for patients experiencing deteriorating health status. The information may assist in determining team training strategies and structures to facilitate patient management during deterioration. IMPACT This is among the first study to investigate barriers influencing decision-making of RNs prior to escalation using qualitative methods. This study provides a foundation to inform and develop policies and strategies aimed at ensuring escalation occurs for deteriorating patients.
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Affiliation(s)
| | - Mariann Fossum
- Alfred Health, Melbourne, Vic., Australia.,Centre for Caring Research - Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway
| | | | - Robin Digby
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Vic., Australia
| | - Tracey Bucknall
- Alfred Health, Melbourne, Vic., Australia.,Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Vic., Australia
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18
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Succeeding with rapid response systems – a never-ending process: A systematic review of how health-care professionals perceive facilitators and barriers within the limbs of the RRS. Resuscitation 2019; 144:75-90. [DOI: 10.1016/j.resuscitation.2019.08.034] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 08/15/2019] [Accepted: 08/24/2019] [Indexed: 11/24/2022]
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Chung C, McKenna L, Cooper SJ. Patients' experiences of acute deterioration: A scoping review. Int J Nurs Stud 2019; 101:103404. [PMID: 31670222 DOI: 10.1016/j.ijnurstu.2019.103404] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 07/05/2019] [Accepted: 08/20/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Patient experience is recognised as a means of assessing healthcare delivery with organisations in many countries now gathering patient experience or satisfaction data. It is well documented that the benefits of improving a patients' experience include increased satisfaction, reduced length of stay, improved patient outcomes and reduction of costs. The experience of acute clinical deterioration is unique, extensive and complex as well as being a difficult experience for all involved. However, little is known about this experience from the patient's perspective. AIM To explore what is known about the experiences of acute deterioration from the perspective of the patient. DESIGN A scoping review of international, peer-reviewed research studies and grey literature published between the years of 2000 and 2018. This review was guided by the three-step search strategy recommended by the Joanna Briggs Institute (JBI). DATA SOURCES A range of databases were searched, including CINAHL, Medline, Health Source, Joanna Briggs Institute, PsycINFO, Embase via Ovid, Cochrane library, Ovid Emcare, Scopus as well as grey literature, reference lists and the search engine Google Scholar. REVIEW METHODS Joanna Briggs Institute (JBI) scoping review framework was utilised to identify patients' experiences of acute deterioration. Ten databases were searched, and 249 articles were retrieved. After screening the titles and abstracts, 102 articles were assessed in full text for eligibility, and finally 23 articles were further analysed and synthesised using inductive thematic analysis. RESULTS 19 qualitative studies, three quantitative and one mixed methods study met the inclusion criteria. Seven key themes emerged related to patients' experience of acute deterioration: (1) transformation of perception: memories of factual events; (2) psychological transformation: emotional distress and well-being; (3) physiological transformation: physical distress; (4) facing death; (5) the severity of acute deterioration: from the perspective of the patient; (6) relationship with healthcare professionals and the clinical environment; and (7) the value of relationships: the support of family and friends. CONCLUSIONS Participants had considerable recall of their experiences and hospital admissions. The themes highlight the important issues patients face during their own acute physiological deterioration. This review has highlighted that further research is needed to specifically explore the patients' experience of acute deterioration and the emergency management they receive, for example from a hospital's rapid response team (RRT) or medical emergency team (MET).
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Affiliation(s)
- Catherine Chung
- Nursing and Healthcare Professions, Federation University Australia, Northways Rd., Churchill, Victoria 3842, Australia.
| | - Lisa McKenna
- Nursing and Healthcare Professions, Federation University Australia, Northways Rd., Churchill, Victoria 3842, Australia; School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086, Australia
| | - Simon J Cooper
- Nursing and Healthcare Professions, Federation University Australia, Northways Rd., Churchill, Victoria 3842, Australia
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20
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Allen J, Orellana L, Jones D, Considine J, Currey J. Associations between patient and system characteristics and MET review within 48 h of admission to a teaching hospital: A retrospective cohort study. Eur J Intern Med 2019; 66:62-68. [PMID: 31155230 DOI: 10.1016/j.ejim.2019.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/21/2019] [Accepted: 05/20/2019] [Indexed: 10/26/2022]
Abstract
The Medical Emergency Team (MET) has enhanced the recognition and response to clinical deterioration in acute healthcare. However, patients reviewed by the MET are at increased risk of in-hospital death. Identifying patients at risk of deterioration may improve patient outcomes. AIM: To identify patient demographic, medical characteristics and healthcare systems and processes at the time of admission (baseline), associated with Medical Emergency Team (MET) review within 48 h (MET-48 h) of admission. METHODS: Single-site, year-long, retrospective cohort comprising patients admitted for at least 24 h, using routinely collected hospital data. A three-stage modelling approach was used to identify baseline factors associated with MET-48 h RESULTS: The study included 15,695 patients with mean age 62.1 years (SD 19.6), male (53.5%), born in Australia or New Zealand (60.9%) and 51.6% held a low-income concession card. A total of 4.3% of patients received a MET review within 48 h of admission. Variables independently associated with MET-48 h in a fully adjusted logistic model included age of 80 years or more (OR = 1.37); ≥3 previous emergency admissions (OR = 1.59); Charlson Comorbidity Index 1 or 2 (OR = 1.47), or ≥ 3 (OR = 1.99); history of alcohol-related behaviour concerns (OR = 2.04), chronic heart failure (OR = 1.48); chronic obstructive pulmonary disease (OR = 1.35); admission for colorectal (OR = 2.66) or upper gastro-intestinal (OR = 1.94) surgery, respiratory or tracheostomy (OR = 2.24); immunology and infections (OR = 1.90); emergency admission (OR = 1.36); admission at night (OR = 1.74), or summer (OR = 1.41) CONCLUSIONS: This is the first study to demonstrate the potential to predict clinical deterioration using data that is readily accessible at the time of admission to hospital.
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Affiliation(s)
- Joshua Allen
- Deakin University, Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Faculty of Health, Geelong, VIC 3220, Australia.
| | - Liliana Orellana
- Deakin University, Biostatistics Unit, Faculty of Health, Geelong, VIC 3220, Australia.
| | - Daryl Jones
- DEPM Monash University, Level 6 The Alfred Centre (Alfred Hospital), 99 Commercial Road, Melbourne, Victoria 3004, Australia; Department of Surgery University of Melbourne, Austin Hospital, Studley Road Heidelberg, Victoria 3084, Australia; Intensive Care Unit, Austin Hospital, Studley Road Heidelberg, Victoria 3084, Australia.
| | - Julie Considine
- Deakin University, Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Faculty of Health, Geelong, VIC 3220, Australia; Centre for Quality and Patient Safety Research - Eastern Health Partnership, 2/5 Arnold Street, Box Hill, VIC 3128, Australia.
| | - Judy Currey
- Deakin University, Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Faculty of Health, Geelong, VIC 3220, Australia.
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21
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Wood C, Chaboyer W, Carr P. How do nurses use early warning scoring systems to detect and act on patient deterioration to ensure patient safety? A scoping review. Int J Nurs Stud 2019; 94:166-178. [DOI: 10.1016/j.ijnurstu.2019.03.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 03/17/2019] [Accepted: 03/18/2019] [Indexed: 10/27/2022]
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22
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Strickland W, Pirret A, Takerei S. Patient and/or family activated rapid response service: Patients' perceptions of deterioration and need for a service. Intensive Crit Care Nurs 2018; 51:20-26. [PMID: 30579825 DOI: 10.1016/j.iccn.2018.11.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 09/14/2018] [Accepted: 11/19/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patient and/or family activated escalation may improve care to deteriorating patients. However, limited literature describes patients' and families' experience of deterioration and what barriers might restrict call activation. OBJECTIVE This study explored patients' and families' experiences of acute ward deterioration, their perception of a need for a patient and/or family activated escalation service and barriers that may prevent them from using it. DESIGN Using a qualitative cross sectional research design and a co-design approach, data were collected using face-to-face semi-structured interviews, field notes and reflective journaling. Between December 2015 and February 2016, purposeful sampling recruited 41 adult ward patients and family who either experienced a recent Medical Emergency team (MET) or Patient at Risk team (PART) escalation, or no recent MET or PART escalation. FINDINGS Themes included: (1) patient awareness of their illness and deterioration, 2) the importance of returning to their normal lives, (3) reassurance on arrival of the PART and MET, (4) beliefs held to prevent use of such a service, and (5) support for a patient and/or family activated escalation service. CONCLUSION Most participants supported a patient and/or family activated escalation service, however barriers may prevent some patients from using it.
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Affiliation(s)
| | - Alison Pirret
- Critical Care Complex, Middlemore Hospital, New Zealand; School of Nursing, Massey University, New Zealand
| | - Susan Takerei
- Critical Care Complex, Middlemore Hospital, New Zealand
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23
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Allen J, Jones D, Currey J. Clinician and manager perceptions of factors leading to ward patient clinical deterioration. Aust Crit Care 2017; 31:369-375. [PMID: 29153825 DOI: 10.1016/j.aucc.2017.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 09/20/2017] [Accepted: 09/22/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Improving the timely recognition and response to clinical deterioration is a critical challenge for clinicians, educators, administrators and researchers. Clinical deterioration leading to Rapid Response Team review is associated with poor patient outcomes. A range of factors associated with clinical deterioration and its outcomes have been identified, and may help with early identification of deteriorating patients. However, the relative importance of each factor on the development of clinical deterioration is unknown. OBJECTIVE To identify the relative importance of factors contributing to the development of clinical deterioration in ward patients, as perceived by health professionals who have experience in recognising or responding to clinical deterioration, or in the management, administration or governance of RRSs. METHODS A written questionnaire containing 12 pre-determined factors was provided to participants. Participants were asked to rank the items from most to least important contributors to ward patient deterioration. The study took place during a session of the Australia and New Zealand Intensive Care Society Rapid Response Team conference. RESULTS A final sample of 233 (83% response rate), returned the questionnaire. The sample comprised specialist ICU registered nurses with direct patient contact (64%), ICU consultant doctors (17%), ICU nurse managers (7%), hospital administrators (2%), ICU registrars (2%), quality coordinators (2%) and non-hospital staff (4%). The patient's presenting illness/main diagnosis was the highest ranked factor, followed by pre-existing co-morbidities, seniority of nursing ward staff, medical documentation, senior medical staff, and interdisciplinary communication. Almost two-thirds of participants ranked patient characteristics as the most important contributor to clinical deterioration. CONCLUSION Health professionals who have experience in recognising or responding to clinical deterioration, or in the management, administration or governance of RRSs perceive that patient characteristics such as the patient's primary diagnosis and comorbidities to be the most important contributors to clinical deterioration.
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Affiliation(s)
- Joshua Allen
- Deakin University, Geelong, Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Faculty of Health, Victoria 3125, Australia.
| | - Daryl Jones
- DEPM Monash University, Level 6 The Alfred Centre (Alfred Hospital), 99 Commercial Road, Melbourne, Victoria 3004, Australia; Department of Surgery, University of Melbourne, Parkville, Victoria 3010, Australia; Intensive Care Unit, Austin Hospital, Studley Road Heidelberg, Victoria 3084, Australia.
| | - Judy Currey
- Deakin University, Geelong, Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Faculty of Health, Victoria 3125, Australia.
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