Importance of specific vital signs in nurses' recognition and response to deteriorating patients: A scoping review

Prognostic Factors Associated With Survival Distribution of Admission to Delayed Rapid Response Team Activation Among Deteriorating Patients: A Retrospective Study

AIMS

To investigate the prevalence of rapid response team delays, survival distribution of admission to rapid response team delay and its prognostic factors.

DESIGN

A retrospective single-centre study.

METHODS

Data on rapid response team activations from 1 January 2018 to 31 December 2022 were retrieved from electronic medical records at a tertiary hospital in Hangzhou, China. All patients who met the eligibility criteria were included. Multivariable Cox regression analysis was conducted to analyse the data.

RESULTS

Out of 636 patients included, 18.4% (117) experienced a delay, with a median (interquartile range) of 8.5 (12) days from admission to rapid response team activation. Six significant prognostic factors were found to be associated with the higher hazard ratio of rapid response team delay, including call time (05:01 PM and 7:59 AM), emergency admission, a higher Modified Early Warning Score, an admission diagnosis of infection, a comorbidity of respiratory failure/Acute Respiratory Distress Syndrome and the absence of lung infection.

CONCLUSION

The prevalence of rapid response team delays was lower, and the days from admission to rapid response team delay was longer than in previous studies. Healthcare providers are suggested to prioritise the care of high-risk patient groups and provide proactive monitoring to ensure timely identification and management.

IMPLICATIONS FOR PATIENT CARE

Implementing artificial intelligence in continuous monitoring systems for high-risk patients is recommended. The findings help nurses anticipate potential delays in rapid response team activation, enabling better preparedness.

IMPACT

The study highlights the prevalence of rapid response team delays, timing from admission to rapid response team activation and six prognostic factors influencing delays. It could shape patient care and inform future research. Hospital administrators should review staffing, especially during night shifts, to minimise delays. Further qualitative research is needed to explore why nurses may delay rapid response team activation.

REPORTING METHOD

The STROBE checklist was adhered to when reporting this study. 'No patient or public contribution'.

Attitude toward vital signs monitoring and its predictors among clinical nurses in Saudi Arabia

Positive attitudes toward assessing vital signs are essential in ensuring quality assessments and recognizing patients' declining conditions. However, few studies have been conducted that examine the attitudes of nurses toward this fundamental nursing skill. This research investigated the predictors of clinical nurses' attitudes toward vital signs monitoring in identifying the patients' deteriorating state. A cross-sectional, correlational study was conducted in two hospitals in Saudi Arabia. A sample of 427 clinical nurses was surveyed from February 2023 and April 2023 using a questionnaire on attitudes toward vital signs monitoring. The subscale "key indicators" achieved the highest mean, followed by "workload," "communication," and "knowledge." The hospital where the nurses work (Hospitals 1 and 2), younger age, gender (being male), marital status (being single), clinical area (working in intensive care unit), number of handled patients per shift (handling 11-20 and > 20 patients), and longer years of experience were identified as significant predictors of the nurses' positive attitude toward vital signs monitoring. This research provides valuable knowledge on which aspect of the attitudes toward vital signs monitoring necessitates educational enhancement among clinical nurses. The factors influencing the clinical nurses' attitude toward vital signs monitoring reported in this study may be useful for nurse managers and other hospital policymakers in developing focused continuing educational interventions targeting enhanced vital signs monitoring competencies.

Feasibility and acceptability of implementing an evidence-based ESCALATION system for paediatric clinical deterioration

BACKGROUND

The ESCALATION system is a novel paediatric Early Warning System that incorporates family involvement and sepsis recognition. This study aimed to assess the feasibility and iteratively refine the ESCALATION system in a variety of hospital settings in preparation for full-service implementation.

METHODS

A series of four multi-methods studies using an Implementation Science and co-design approach were conducted. We examined concepts of implementation, context, and mechanisms of action across a variety of hospitals. Data collected included practice and chart audits, surveys (health professionals), interviews (families) and focus groups (health professionals). Quantitative data were analysed descriptively with qualitative findings assessed by content analysis or thematic analysis.

RESULTS

There were 650 audits (Study I-IV), 205 health professional survey responses (Study I), 154 health professionals participated in focus groups (Study II-IV), 13 parents of hospitalised children interviewed (Study I), and 107 parents reported their involvement in the ESCALATION system (Study III-IV). Each of the studies further refined and confirmed the feasibility, specifically the components of family involvement and the sepsis recognition pathway.

CONCLUSION

The Implementation Science evaluation of the ESCALATION system resulted in a uniform approach that was feasible and acceptable to users and appropriate for full-service implementation.

IMPACT

This series of four studies used a co-production approach built on the Medical Research Council framework to understand feasibility and acceptability of an intervention to improve recognition and response to clinical deterioration in children to the point of full-service implementation. We have reported a detailed, systematic approach to assessing feasibility and acceptability of a complex intervention using established methodologies for whole of health system implementation. The ESCALATION System is an evidence based paediatric early warning system that is a highly refined, well accepted and accommodates a health system that has substantial contextual variation.