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A scoping review of barriers, facilitators and tools to escalation of care processes in the emergency department. CAN J EMERG MED 2022; 24:300-312. [DOI: 10.1007/s43678-022-00268-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 01/14/2022] [Indexed: 11/02/2022]
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Munroe B, Curtis K, Balzer S, Roysten K, Fetchet W, Tucker S, Pratt W, Morris R, Fry M, Considine J. Translation of evidence into policy to improve clinical practice: the development of an emergency department rapid response system. Australas Emerg Care 2020; 24:197-209. [PMID: 32950439 DOI: 10.1016/j.auec.2020.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/18/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Undetected clinical deterioration is a major cause of high mortality events in Emergency Department (ED) patients. Yet, there is no known model to guide the recognition and response to clinical deterioration in the ED, integrating internal and external resources. METHODS An integrative review was firstly conducted to identify the critical components of recognising and responding to clinical deterioration in the ED. Components identified from the review were analysed by clinical experts and informed the development of an ED Clinical Emergency Response System (EDCERS). RESULTS Twenty four eligible studies were included in the review. Eight core components were identified: 1) vital sign monitoring; 2) track and trigger system; 3) communication plan; 4) response time; 5) emergency nurse response; 6) emergency physician response; 7) critical care team response; and 8) specialty team response. These components informed the development of the EDCERS protocol, integrating responses from staff internal and external to the ED. CONCLUSIONS EDCERS was based on the best available evidence and considered the cultural context of care. Future research is needed to determine the useability and impact of EDCERS on patient and health outcomes.
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Affiliation(s)
- Belinda Munroe
- Faculty of Medicine and Health, The University of Sydney Susan Wakil School of Nursing and Midwifery, Mallet St, Camperdown, NSW, Australia; Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia.
| | - Kate Curtis
- Faculty of Medicine and Health, The University of Sydney Susan Wakil School of Nursing and Midwifery, Mallet St, Camperdown, NSW, Australia; Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Sharyn Balzer
- Emergency Department, Shoalhaven Memorial District Hospital, Shoalhaven, NSW, Australia
| | - Karlie Roysten
- Clinical Emergency Response, Executive Services, Shoalhaven Hospital Groups, Shoalhaven, NSW, Australia
| | - Wendy Fetchet
- Emergency Department, Shoalhaven Memorial District Hospital, Shoalhaven, NSW, Australia
| | - Simon Tucker
- Emergency Department, Shoalhaven Memorial District Hospital, Shoalhaven, NSW, Australia
| | - William Pratt
- Department of Medicine, Shoalhaven Memorial District Hospital, Shoalhaven, NSW, Australia
| | - Richard Morris
- Intensive Care Unit, Shoalhaven Memorial District Hospital, Shoalhaven, NSW, Australia; Faculty of Medicine, University of NSW
| | - Margaret Fry
- University of Technology Sydney School of Nursing and Midwifery Broadway NSW 2007; Northern Sydney Local Health District
| | - Julie Considine
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, and Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia; Centre for Quality and Patient Safety Research - Eastern Health Partnership, Eastern Health, Box Hill, Victoria, Australia
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Innes K, Jackson D, Plummer V, Elliott D. A profile of the waiting room nurse in emergency departments: An online survey of Australian nurses exploring implementation and perceptions. Int Emerg Nurs 2018; 43:67-73. [PMID: 30381142 DOI: 10.1016/j.ienj.2018.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 08/27/2018] [Accepted: 10/12/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND In response to increasing waiting times, adverse patient outcomes and patient dissatisfaction, some emergency departments introduced a Waiting Room Nurse role. Despite implementation into routine practice, there remains limited formal evaluation of the role. AIM To explore the implementation of a Waiting Room Nurse role in Australian emergency departments and emergency nurses' perceptions. METHODS Survey design. A 40-item survey was developed, piloted and then distributed to members of a professional College for online completion. Responses for closed-ended and open-ended items were reported using frequencies or proportions, and quantitative content analysis, respectively. RESULTS Respondents (n = 197) reported that 51 emergency departments allocated a Waiting Room Nurse, with varying hours of operation. Five key areas of responsibility were: patient care, patient safety, escalation of care, triage and communication. Role variations were identified in experience, preparation and supporting policies. Challenges, including workload and personal safety issues, were reported. CONCLUSIONS The role was perceived as vital, especially at times of high demand, in ensuring that patients were safe to wait, detecting deterioration and escalating care as needed. Communication and therapeutic relationships were key to effective performance. Challenges identified had clear implications for the welfare of nurses performing the role.
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Affiliation(s)
- Kelli Innes
- Faculty of Health University of Technology Sydney, 15 Broadway, Ultimo, N.S.W 2007, Australia; Nursing and Midwifery, Monash University, 47-49 Moorooduc Highway, Frankston, Victoria 3199, Australia.
| | - Debra Jackson
- Faculty of Health University of Technology Sydney, 15 Broadway, Ultimo, N.S.W 2007, Australia.
| | - Virginia Plummer
- Nursing and Midwifery, Monash University, 47-49 Moorooduc Highway, Frankston, Victoria 3199, Australia; Peninsula Health, 2 Hastings Road, Frankston, Victoria 3199, Australia.
| | - Doug Elliott
- Faculty of Health University of Technology Sydney, 15 Broadway, Ultimo, N.S.W 2007, Australia.
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Wuytack F, Meskell P, Conway A, McDaid F, Santesso N, Hickey FG, Gillespie P, Raymakers AJN, Smith V, Devane D. The effectiveness of physiologically based early warning or track and trigger systems after triage in adult patients presenting to emergency departments: a systematic review. BMC Emerg Med 2017; 17:38. [PMID: 29212452 PMCID: PMC5719672 DOI: 10.1186/s12873-017-0148-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 11/21/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Changes to physiological parameters precede deterioration of ill patients. Early warning and track and trigger systems (TTS) use routine physiological measurements with pre-specified thresholds to identify deteriorating patients and trigger appropriate and timely escalation of care. Patients presenting to the emergency department (ED) are undiagnosed, undifferentiated and of varying acuity, yet the effectiveness and cost-effectiveness of using early warning systems and TTS in this setting is unclear. We aimed to systematically review the evidence on the use, development/validation, clinical effectiveness and cost-effectiveness of physiologically based early warning systems and TTS for the detection of deterioration in adult patients presenting to EDs. METHODS We searched for any study design in scientific databases and grey literature resources up to March 2016. Two reviewers independently screened results and conducted quality assessment. One reviewer extracted data with independent verification of 50% by a second reviewer. Only information available in English was included. Due to the heterogeneity of reporting across studies, results were synthesised narratively and in evidence tables. RESULTS We identified 6397 citations of which 47 studies and 1 clinical trial registration were included. Although early warning systems are increasingly used in EDs, compliance varies. One non-randomised controlled trial found that using an early warning system in the ED may lead to a change in patient management but may not reduce adverse events; however, this is uncertain, considering the very low quality of evidence. Twenty-eight different early warning systems were developed/validated in 36 studies. There is relatively good evidence on the predictive ability of certain early warning systems on mortality and ICU/hospital admission. No health economic data were identified. CONCLUSIONS Early warning systems seem to predict adverse outcomes in adult patients of varying acuity presenting to the ED but there is a lack of high quality comparative studies to examine the effect of using early warning systems on patient outcomes. Such studies should include health economics assessments.
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Affiliation(s)
- Francesca Wuytack
- School of Nursing & Midwifery, National University of Ireland Galway, Galway, County Galway, Ireland
| | - Pauline Meskell
- School of Nursing & Midwifery, National University of Ireland Galway, Galway, County Galway, Ireland
| | - Aislinn Conway
- Health Research Board Trials Methodology Research Network, Galway, Ireland
| | - Fiona McDaid
- Nurse Lead, National Emergency Medicine Programme/Clinical Nurse Manager, Emergency Department, Naas General Hospital, Naas, County Kildare Ireland
| | - Nancy Santesso
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St. W., HSC-2C15, Hamilton, ON L8S 4K1 Canada
| | | | - Paddy Gillespie
- Health Economics & Policy Analysis Centre (HEPAC), School of Business & Economics, National University of Ireland Galway, Galway, County Galway, Ireland
| | - Adam J. N. Raymakers
- Health Economics & Policy Analysis Centre (HEPAC), School of Business & Economics, National University of Ireland Galway, Galway, County Galway, Ireland
| | - Valerie Smith
- School of Nursing & Midwifery, National University of Ireland Galway, Galway, County Galway, Ireland
| | - Declan Devane
- School of Nursing & Midwifery, National University of Ireland Galway, Galway, County Galway, Ireland
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Ward M, McAuliffe E, Wakai A, Geary U, Browne J, Deasy C, Schull M, Boland F, McDaid F, Coughlan E, O’Sullivan R. Study protocol for evaluating the implementation and effectiveness of an emergency department longitudinal patient monitoring system using a mixed-methods approach. BMC Health Serv Res 2017; 17:67. [PMID: 28114987 PMCID: PMC5260070 DOI: 10.1186/s12913-017-2014-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 01/13/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Early detection of patient deterioration is a key element of patient safety as it allows timely clinical intervention and potential rescue, thus reducing the risks of serious patient safety incidents. Longitudinal patient monitoring systems have been widely recommended for use to detect clinical deterioration. However, there is conflicting evidence on whether they improve patient outcomes. This may in part be related to variation in the rigour with which they are implemented and evaluated. This study aims to evaluate the implementation and effectiveness of a longitudinal patient monitoring system designed for adult patients in the unique environment of the Emergency Department (ED). METHODS A novel participatory action research (PAR) approach is taken where socio-technical systems (STS) theory and analysis informs the implementation through the improvement methodology of 'Plan Do Study Act' (PDSA) cycles. We hypothesise that conducting an STS analysis of the ED before beginning the PDSA cycles will provide for a much richer understanding of the current situation and possible challenges to implementing the ED-specific longitudinal patient monitoring system. This methodology will enable both a process and an outcome evaluation of implementing the ED-specific longitudinal patient monitoring system. Process evaluations can help distinguish between interventions that have inherent faults and those that are badly executed. DISCUSSION Over 1.2 million patients attend EDs annually in Ireland; the successful implementation of an ED-specific longitudinal patient monitoring system has the potential to affect the care of a significant number of such patients. To the best of our knowledge, this is the first study combining PAR, STS and multiple PDSA cycles to evaluate the implementation of an ED-specific longitudinal patient monitoring system and to determine (through process and outcome evaluation) whether this system can significantly improve patient outcomes by early detection and appropriate intervention for patients at risk of clinical deterioration.
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Affiliation(s)
- Marie Ward
- School of Nursing, Midwifery and Health Systems, College of Health Sciences, University College Dublin, Belfield, Dublin 4, Ireland
| | - Eilish McAuliffe
- School of Nursing, Midwifery and Health Systems, College of Health Sciences, University College Dublin, Belfield, Dublin 4, Ireland
| | - Abel Wakai
- Emergency Care Research Unit (ECRU), Division of Population Health Sciences (PHS), Royal College of Surgeons in Ireland (RCSI), Dublin 2, Ireland
- Department of Emergency Medicine, Beaumont Hospital, Dublin 9, Ireland
| | - Una Geary
- Department of Emergency Medicine, St James’s Hospital, Dublin 8, Ireland
| | - John Browne
- Department of Epidemiology and Public Health, University College Cork, Western Rd, Cork, Ireland
| | - Conor Deasy
- Department of Emergency Medicine, Cork University Hospital, Cork, Ireland
| | - Michael Schull
- Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Fiona Boland
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Fiona McDaid
- Department of Emergency Medicine, Naas Hospital, Naas, Co, Kildare, Ireland
| | - Eoin Coughlan
- Department of Epidemiology and Public Health, University College Cork, Western Rd, Cork, Ireland
| | - Ronan O’Sullivan
- School of Medicine, University College Cork, Western Rd, Cork, Ireland
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