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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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Nolan J, Mackay I, Nolan T, de Looze J. Medical Emergency Team call within 24 h of medical admission with a focus on sepsis: a retrospective review. Intern Med J 2024; 54:961-969. [PMID: 38288844 DOI: 10.1111/imj.16337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 12/28/2023] [Indexed: 06/18/2024]
Abstract
BACKGROUND AND AIMS Clinical deterioration within the first 24 h of patient admission triggering a Medical Emergency Team (MET) call is a common occurrence. A greater understanding of these events, with a focus on the recognition and management of sepsis, could lead to quality improvement interventions. METHODS A retrospective observational review of general and subspecialty medical admissions triggering a MET call within 24 h of admission at a quaternary Australian hospital. RESULTS 2648 MET calls occurred (47.9/1000 admissions), 527 (20% of total MET events, 9.5/1000 admissions) within 24 h of admission, with the trigger more likely to be hypotension (odds ratio: 1.5, P = 0.0013). There were 263 MET calls to 217 individual medical patients within 24 h of admission, of which 84 (38.7%) were admitted with suspected infection, 69% of which fulfilled sepsis criteria. Of these, 36.2% received antimicrobial therapy within the recommended timeframe and 39.6% received antibiotics in line with hospital guidelines. Sepsis was initially missed in 11% of patients. Afferent limb failure occurred in 29% of patients with 40.5% experiencing a failure of the ward-based response to deterioration prior to MET call. Median hospital length of stay was increased in patients admitted with suspected infection (7 vs 5 days, P = 0.015) and in those with sepsis not receiving antimicrobial therapy within guideline timeframes (9 vs 4 days, P = 0.017). CONCLUSION There is a significant opportunity to improve care for patients who trigger a MET within 24 h of admission. This study supports the implementation of a hospital sepsis management guideline.
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Affiliation(s)
- James Nolan
- Internal Medicine and Aged Care, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Ian Mackay
- Internal Medicine and Aged Care, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Timothy Nolan
- The Cairns Hospital, Cairns, Queensland, Australia
- Griffith University, Gold Coast, Queensland, Australia
| | - Julian de Looze
- Internal Medicine and Aged Care, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
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Jones D, Kishore K, Eastwood G, Sprogis SK, Glassford NJ. Breaches of pre-medical emergency team call criteria in an Australian hospital. CRIT CARE RESUSC 2023; 25:223-228. [PMID: 38234322 PMCID: PMC10790013 DOI: 10.1016/j.ccrj.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/03/2023] [Indexed: 01/19/2024]
Abstract
Objectives and outcomes To evaluate the 24hrs before medical emergency team (MET) calls to examine: 1) the frequency, nature, and timing of pre-MET criteria breaches; 2) differences in characteristics and outcomes between patients who did and didn't experience pre-MET breaches. Design Retrospective observational study November 2020-June 2021. Setting Tertiary referral Australian hospital. Participants Adults (≥18 years) experiencing MET calls. Results Breaches in pre-MET criteria occurred prior to 1886/2255 (83.6%) MET calls, and 1038/1281 (81.0%) of the first MET calls. Patients with pre-MET breaches were older (median [IQR] 72 [57-81] vs 66 [56-77] yrs), more likely to be admitted from home (87.8% vs 81.9%) and via the emergency department (73.0% vs 50.2%), but less likely to be for full resuscitation after (67.3% vs 76.5%) the MET. The three most common pre-MET breaches were low SpO2 (48.0%), high pulse rate (39.8%), and low systolic blood pressure (29.0%) which were present for a median (IQR) of 15.4 (7.5-20.8), 13.2 (4.3-21.0), and 12.6 (3.5-20.1) hrs before the MET call, respectively. Patients with pre-MET breaches were more likely to need intensive care admission within 24 h (15.6 vs 11.9%), have repeat MET calls (33.3 vs 24.7%), and die in hospital (15.8 vs 9.9%). Conclusions Four-fifths of MET calls were preceded by pre-MET criteria breaches, which were present for many hours. Such patients were older, had more limits of treatment, and experienced worse outcomes. There is a need to improve goals of care documentation and pre-MET management of clinical deterioration.
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Affiliation(s)
- Daryl Jones
- Intensive Care Unit, Austin Hospital, Studley Road, Heidelberg, Victoria, 3084, Australia
- Monash Health, Clayton Road, Clayton, Australia
- Division of Acute and Critical Care, SPHPM, Monash University, Australia
| | - Kartik Kishore
- Bachelor of Technology - Computer Science & Engineering, Data Analytics Research and Evaluation (DARE) Centre, Austin Health, Australia
| | - Glenn Eastwood
- Intensive Care Research Manager, Austin Health, Studley Road, Heidelberg, Germany
- Senior Research Fellow SPHPM, Monash University, 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
| | - Neil J. Glassford
- Austin Health, Melbourne, Victoria, Australia
- Monash Health, Clayton Road, Clayton, Australia
- Division of Acute and Critical Care, SPHPM, Monash University, Australia
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, Australia
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Smith D, Aitken LM. Rethinking the problem of clinically deteriorating patients: Time for theory-informed solutions. Aust Crit Care 2023; 36:925-927. [PMID: 37716883 DOI: 10.1016/j.aucc.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 09/02/2023] [Indexed: 09/18/2023] Open
Affiliation(s)
- Duncan Smith
- City, University of London, School of Health & Psychological Sciences, Northampton Square, London, EC1V 0HB, UK; Patient Emergency Response & Resuscitation Team (PERRT), University College London Hospitals NHS Foundation Trust, Euston Road, London, NW1 2BU, UK.
| | - Leanne M Aitken
- City, University of London, School of Health & Psychological Sciences, Northampton Square, London, EC1V 0HB, UK; School of Nursing and Midwifery, Griffith University, Nathan, QLD, 4111, Australia.
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Jones PD. Deteriorating patients in Australian hospitals - Current issues and future opportunities. Aust Crit Care 2023; 36:928-930. [PMID: 37620214 DOI: 10.1016/j.aucc.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
Affiliation(s)
- Prof Daryl Jones
- Intensive Care Unit Austin Hospital, Studley Road Heidelberg, Victoria, 3084, 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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Considine J, Hutchinson AM, Mitchell I, Bohingamu Mudiyanselage S, Mohebbi M, Watts JJ, Bucknall T. Vital sign assessment and nursing interventions in medical and surgical patients with rapid response system triggers. J Clin Nurs 2023; 32:7310-7320. [PMID: 37365897 PMCID: PMC10946594 DOI: 10.1111/jocn.16810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/01/2023] [Accepted: 06/09/2023] [Indexed: 06/28/2023]
Abstract
AIM(S) To explore vital sign assessment (both complete and incomplete sets of vital signs), and escalation of care per policy and nursing interventions in response to clinical deterioration. DESIGN This cohort study is a secondary analysis of data from the Prioritising Responses of Nurses To deteriorating patient Observations cluster randomised controlled trial of a facilitation intervention on nurses' vital sign measurement and escalation of care for deteriorating patients. METHODS The study was conducted in 36 wards at four metropolitan hospitals in Victoria, Australia. Medical records of all included patients from the study wards during three randomly selected 24-h periods within the same week were audited at three time points: pre-intervention (June 2016), and at 6 (December 2016) and 12 months (June 1017) post-intervention. Descriptive statistics were used to summarise the study data, and relationships between variables were examined using chi-square test. RESULTS A total of 10,383 audits were conducted. At least one vital sign measurement was documented every 8 h in 91.6% of audits, and a complete set of vital signs was documented every 8 h in 83.1% of audits. There were pre-Medical Emergency Team, Medical Emergency Team or Cardiac Arrest Team triggers in 25.8% of audits. When triggers were present, a rapid response system call occurred in 26.8% of audits. There were 1350 documented nursing interventions in audits with pre-Medical Emergency Team (n = 2403) or Medical Emergency Team triggers (n = 273). One or more nursing interventions were documented in 29.5% of audits with pre-Medical Emergency Team triggers and 63.7% of audits with Medical Emergency Team triggers. CONCLUSION When rapid response system triggers were documented, there were gaps in escalation of care per policy; however, nurses undertook a range of interventions within their scope of practice in response to clinical deterioration. RELEVANCE TO CLINICAL PRACTICE Medical and surgical ward nurses in acute care wards frequently engage in vital sign assessment. Interventions by medical and nurgical nurses may occur prior to, or in parallel with calling the rapid response system. Nursing interventions are a key but under-recognised element of the organisational response to deteriorating patients. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Nurses engage in a range of nursing interventions to manage deteriorating patients, (aside from rapid response system activation) that are not well understood, nor well described in the literature to date. IMPACT This study addresses the gap in the literature regarding nurses' management of deteriorating patients within their scope of practice (aside from RRS activation) in real world settings. When rapid response system triggers were documented, there were gaps in escalation of care per policy; however, nurses undertook a range of interventions within their scope of practice in response to clinical deterioration. The results of this research are relevant to nurses working on medical and surgical wards. REPORTING METHOD The trial was reported according to the Consolidated Standards of Reporting Trials extension for Cluster Trials recommendations, and this paper is reported according to the Strengthening the Reporting of Observational Studies in Epidemiology Statement. PATIENT OR PUBLIC CONTRIBUTION No Patient or Public Contribution.
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Affiliation(s)
- Julie Considine
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Research in the Institute for Health TransformationDeakin UniversityGeelongAustralia
- Centre for Quality and Patient Safety Research – Eastern Health PartnershipBox HillAustralia
| | - Alison M. Hutchinson
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Research in the Institute for Health TransformationDeakin UniversityGeelongAustralia
- Centre for Quality and Patient Safety Research – Barwon Health PartnershipGeelongAustralia
| | - Imogen Mitchell
- Research and Academic PartnershipsCanberra Health ServicesCanberraAustralian Capital TerritoryAustralia
- Australian National University College of Health and MedicineCanberraAustralian Capital TerritoryAustralia
| | - Shalika Bohingamu Mudiyanselage
- School of Health and Social Development, Deakin Health Economics, Institute for Health Transformation, Faculty of HealthDeakin UniversityGeelongAustralia
| | | | - Jennifer J. Watts
- School of Health and Social Development, Deakin Health Economics, Institute for Health Transformation, Faculty of HealthDeakin UniversityGeelongAustralia
| | - Tracey Bucknall
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Research in the Institute for Health TransformationDeakin UniversityGeelongAustralia
- Centre for Quality and Patient Safety Research – Alfred Health PartnershipMelbourneAustralia
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Jones D, Pearsell J, Wadeson E, See E, Bellomo R. Rapid Response System Components and In-Hospital Cardiac Arrests Rates 21 Years After Introduction Into an Australian Teaching Hospital. J Patient Saf 2023; 19:478-483. [PMID: 37493361 DOI: 10.1097/pts.0000000000001145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
OBJECTIVES The aims of the study are: (1) to evaluate the epidemiology of in-hospital cardiac arrests (IHCAs) 21 years after implementing a rapid response teams (RRTs); and (2) to summarize policies, procedures, and guidelines related to a national standard pertaining to recognition of and response to clinical deterioration in hospital. METHODS The study used a prospective audit of IHCA (commencement of external cardiac compressions) in ward areas between February 1, 2021, and January 31, 2022. Collation, summary, and presentation of material related to 8 "essential elements" of the Australian Commission for Safety and Quality in Health Care consensus statement on clinical deterioration. RESULTS There were 3739 RRT calls and 244 respond blue calls. There were 20 IHCAs in clinical areas, with only 10 occurring in general wards (0.36/1000 admissions). The median (interquartile range) age was 69.5 years (60-77 y), 90% were male, and comorbidities were relatively uncommon. Only 5 patients had a shockable rhythm. Survival was 65% overall, and 80% and 50% in patients on the cardiac and general wards, respectively. Only 4 patients had RRT criteria in the 24 hours before IHCA. A detailed summary is provided on policies and guidelines pertaining to measurement and documentation of vital signs, escalation of care, staffing and oversight of RRTs, communication for safety, education and training, as well as evaluation, audit, and feedback, which underpinned such findings. CONCLUSIONS In our mature RRT, IHCAs are very uncommon, and few are preventable. Many of the published barriers encountered in successful RRT use have been addressed by our policies and guidelines.
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Affiliation(s)
- Daryl Jones
- From the Department of Intensive Care and Deteriorating Patient Committee, Austin Health, Victoria, Australia
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Sprogis SK, Currey J, Jones D, Considine J. Exploring interdisciplinary communication pathways for escalating pre-medical emergency team deterioration: a mixed-methods study. AUST HEALTH REV 2023; 47:494-501. [PMID: 37460097 DOI: 10.1071/ah22203] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 06/22/2023] [Indexed: 08/04/2023]
Abstract
Objective To explore clinicians' use and perceptions of interdisciplinary communication pathways for escalating care within the pre-medical emergency team (pre-MET) tier of rapid response systems. Method A sequential mixed-methods study was conducted using observations and interviews. Participants were clinicians (nurses, allied health, doctors) caring for orthopaedic and general medicine patients at one hospital. Descriptive and thematic analyses were conducted. Results Escalation practices were observed for 13 of 27 pre-MET events. Leading communication methods for escalating pre-MET events were alphanumeric pagers (61.5%) and in-person discussions (30.8%). Seven escalated pre-MET events led to bedside pre-MET reviews by doctors. Clinician interviews (n = 29) culminated in two themes: challenges in escalation of care, and navigating information gaps. Clinicians reported deficiencies in communication methods for escalating care that hindered interdisciplinary communication and clinical decision-making pertaining to pre-MET deterioration. Conclusion Policy-defined escalation pathways were inconsistently utilised for pre-MET deterioration. Available communication methods for escalating pre-MET events inadequately fulfilled clinicians' needs. Variable perceptions of escalation pathways illuminated a lack of of a shared mental model about clinicians' roles and responsibilities. To optimise timely and appropriate management of patient deterioration, communication infrastructure and interdisciplinary collaboration must be enhanced.
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Affiliation(s)
- 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
| | - 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
| | - 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
- 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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Buchholz T, Barzola M, Tayban Y, Halpern NA. A Rapid Response Team (RRT) System at a Cancer Center: Innovative Approaches to System Organization and Clinical RRT Pathways. Crit Care Nurs Q 2023; 46:116-125. [PMID: 36823738 PMCID: PMC10351879 DOI: 10.1097/cnq.0000000000000444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
The Rapid Response Team (RRT) system at Memorial Sloan Kettering Cancer Center led by critical care medicine (CCM) advanced practice providers (APPs) expanded exponentially between 2009 and 2021. CCM-APPs are trained for care of critically ill patients as well as to oversee rapid response calls. The RRT is composed of a CCM-based RRT-APP, respiratory therapist, RRT-RN, and nursing supervisor. Since program inception, 11 RRT pathways and interventions have been developed and adjusted to improve multidisciplinary patient management. Pathways vary in complexity and require multidisciplinary collaboration. In some circumstances, the RRT patient may require transfer to outside facilities for services not provided at our oncology-based facility. RRT data are tracked across the hospital continuum with on-line reporting through RRT website dashboards. 2021 RRT data on electronic sepsis alerts, behavioral RRT and stroke alerts are presented. The RRT program is monitored through robust quality assurance. The APP-led RRT system's scope of care has been continuously expanded through the creation of RRT pathways to meet the increasingly complex medical needs of our patients.
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Affiliation(s)
- Tara Buchholz
- Memorial Sloan Kettering Cancer Center, New York, New York
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Cheng Q, Zheng S, Xiong Z, Lin M. Characterizing the Dynamic Evolution of Interagency Collaborative Decision-Making Networks in Response to COVID-19 in China: A Policy Document Analysis. Healthcare (Basel) 2022; 10:healthcare10030590. [PMID: 35327067 PMCID: PMC8950421 DOI: 10.3390/healthcare10030590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 03/16/2022] [Accepted: 03/18/2022] [Indexed: 01/02/2023] Open
Abstract
Collaborative decision-making across multiple government agencies is considered a critical and effective strategy to combat public health crisis; however, we know little about how the collaborative decision-making works and evolves during periods of crisis. To fill this lacuna, this study uncovers the structure and evolving dynamics of the network by employing a policy document analysis. Based on the policy documents, jointly issued by the agencies of Chinese central government in four phases regarding COVID-19 control, we first constructed a co-occurrence matrix of policy-issuing agencies to outline the network structure, then drew a breadth–depth matrix to identify the role evolution of agencies, and lastly built a two-mode network consisting of policy topics and agencies to determine the evolution mechanisms of policy attentions for each agency. It was found that the network structure of interagency collaboration involves three forms: discrete structure in the early phase, subgroup structure in the middle phase, and connected structure in the latter phase. Agencies embedded in the network can be categorized into three types: leading agencies, key agencies, and auxiliary agencies, with their constituent members changed as the pandemic risks are gradually becoming under control. Furthermore, each type has its own primary policy attentions, but shares some common foci in all four phases and shifts attention in the emergency management process. This study contributes to shedding light on the formation of and variations in collaborative networks in health emergencies and provides policy implications for other countries that have struggled against COVID-19.
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Affiliation(s)
- Quan Cheng
- School of Economics and Management, Fuzhou University, Fuzhou 350108, China; (Q.C.); (S.Z.)
| | - Shulin Zheng
- School of Economics and Management, Fuzhou University, Fuzhou 350108, China; (Q.C.); (S.Z.)
| | - Zheng Xiong
- Department of Foreign Languages, Zhicheng College, Fuzhou University, Fuzhou 350002, China;
| | - Minwang Lin
- School of Economics and Management, Fuzhou University, Fuzhou 350108, China; (Q.C.); (S.Z.)
- Correspondence:
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