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Pham TD, Teh MT, Chatzopoulou D, Holmes S, Coulthard P. Artificial Intelligence in Head and Neck Cancer: Innovations, Applications, and Future Directions. Curr Oncol 2024; 31:5255-5290. [PMID: 39330017 PMCID: PMC11430806 DOI: 10.3390/curroncol31090389] [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: 08/07/2024] [Revised: 09/01/2024] [Accepted: 09/03/2024] [Indexed: 09/28/2024] Open
Abstract
Artificial intelligence (AI) is revolutionizing head and neck cancer (HNC) care by providing innovative tools that enhance diagnostic accuracy and personalize treatment strategies. This review highlights the advancements in AI technologies, including deep learning and natural language processing, and their applications in HNC. The integration of AI with imaging techniques, genomics, and electronic health records is explored, emphasizing its role in early detection, biomarker discovery, and treatment planning. Despite noticeable progress, challenges such as data quality, algorithmic bias, and the need for interdisciplinary collaboration remain. Emerging innovations like explainable AI, AI-powered robotics, and real-time monitoring systems are poised to further advance the field. Addressing these challenges and fostering collaboration among AI experts, clinicians, and researchers is crucial for developing equitable and effective AI applications. The future of AI in HNC holds significant promise, offering potential breakthroughs in diagnostics, personalized therapies, and improved patient outcomes.
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Affiliation(s)
- Tuan D. Pham
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Turner Street, London E1 2AD, UK; (M.-T.T.); (D.C.); (S.H.); (P.C.)
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2
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Sutton E, Ibrahim M, Plath W, Booth L, Sujan M, McCulloch P, Mackintosh N. Understanding the enablers and barriers to implementing a patient-led escalation system: a qualitative study. BMJ Qual Saf 2024:bmjqs-2024-017132. [PMID: 38902021 DOI: 10.1136/bmjqs-2024-017132] [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: 01/16/2024] [Accepted: 05/05/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND The management of acute deterioration following surgery remains highly variable. Patients and families can play an important role in identifying early signs of deterioration but effective contribution to escalation of care can be practically difficult to achieve. This paper reports the enablers and barriers to the implementation of patient-led escalation systems found during a process evaluation of a quality improvement programme Rescue for Emergency Surgery Patients Observed to uNdergo acute Deterioration (RESPOND). METHODS The research used ethnographic methods, including over 100 hours of observations on surgical units in three English hospitals in order to understand the everyday context of care. Observations focused on the coordination of activities such as handovers and how rescue featured as part of this. We also conducted 27 interviews with a range of clinical and managerial staff and patients. We employed a thematic analysis approach, combined with a theoretically focused implementation coding framework, based on Normalisation Process Theory. RESULTS We found that organisational infrastructural support in the form of a leadership support and clinical care outreach teams with capacity were enablers in implementing the patient-led escalation system. Barriers to implementation included making changes to professional practice without discussing the value and legitimacy of operationalising patient concerns, and ensuring equity of use. We found that organisational work is needed to overcome patient fears about disrupting social and cultural norms. CONCLUSIONS This paper reveals the need for infrastructural support to facilitate the implementation of a patient-led escalation system, and leadership support to normalise the everyday process of involving patients and families in escalation. This type of system may not achieve its goals without properly understanding and addressing the concerns of both nurses and patients.
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Affiliation(s)
| | - Mudathir Ibrahim
- Department of General Surgery, Maimonides Medical Center, Brooklyn, New York, USA
| | - William Plath
- Nuffield Department of Surgery, Oxford University, Oxford, UK
| | | | - Mark Sujan
- Human Factors Everywhere, Woking, UK
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Peter McCulloch
- Nuffield Department of Surgery, Oxford University, Oxford, UK
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Bucknall TK, Guinane J, McCormack B, Jones D, Buist M, Hutchinson AM. Listen to me, I really am sick! Patient and family narratives of clinical deterioration before and during rapid response system intervention. J Clin Nurs 2024. [PMID: 38822476 DOI: 10.1111/jocn.17310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 05/08/2024] [Accepted: 05/21/2024] [Indexed: 06/03/2024]
Abstract
AIM To explore patient and family narratives about their recognition and response to clinical deterioration and their interactions with clinicians prior to and during Medical Emergency Team (MET) activations in hospital. BACKGROUND Research on clinical deterioration has mostly focused on clinicians' roles. Although patients and families can identify subtle cues of early deterioration, little research has focused on their experience of recognising, speaking up and communicating with clinicians during this period of instability. DESIGN A narrative inquiry. METHODS Using narrative interviewing techniques, 33 adult patients and 14 family members of patients, who had received a MET call, in one private and one public academic teaching hospital in Melbourne, Australia were interviewed. Narrative analysis was conducted on the data. RESULTS The core story of help seeking for recognition and response by clinicians to patient deterioration yielded four subplots: (1) identifying deterioration, recognition that something was not right and different from earlier; (2) voicing concerns to their nurse or by family members on their behalf; (3) being heard, desiring a response acknowledging the legitimacy of their concerns; and (4) once concerns were expressed, there was an expectation of and trust in clinicians to act on the concerns and manage the situation. CONCLUSION Clinical deterioration results in an additional burden for hospitalised patients and families to speak up, seek help and resolve their concerns. Educating patients and families on what to be concerned about and when to notify staff requires a close partnership with clinicians. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Clinicians must create an environment that enables patients and families to speak up. They must be alert to both subjective and objective information, to acknowledge and to act on the information accordingly. REPORTING METHOD The consolidated criteria for reporting qualitative research (COREQ) guidelines were used for reporting. PATIENT OR PUBLIC CONTRIBUTION The consumer researcher was involved in design, data analysis and publication preparation.
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Affiliation(s)
- Tracey K Bucknall
- School of Nursing & Midwifery, Deakin University, Geelong, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
- Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Jessica Guinane
- School of Nursing & Midwifery, Deakin University, Geelong, Victoria, Australia
| | - Brendan McCormack
- Division of Nursing, Paramedic Science, Occupational Therapy and Arts Therapies, Queen Margaret University, Edinburgh, UK
- Faculty of Medicine and Health, The Susan Wakil School of Nursing and Midwifery, University of Sydney, Sydney, New South Wales, Australia
| | - Daryl Jones
- Austin Health, Melbourne, Victoria, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Buist
- School of Medicine, University of Tasmania, Tasmania, Australia
| | - Alison M Hutchinson
- School of Nursing & Midwifery, Deakin University, Geelong, Victoria, Australia
- Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- Barwon Health, Geelong, Victoria, Australia
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Hammoud S, Alsabek L, Rogers L, McAuliffe E. Systematic review on the frequency and quality of reporting patient and public involvement in patient safety research. BMC Health Serv Res 2024; 24:532. [PMID: 38671476 PMCID: PMC11046929 DOI: 10.1186/s12913-024-11021-z] [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: 01/10/2024] [Accepted: 04/21/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND In recent years, patient and public involvement (PPI) in research has significantly increased; however, the reporting of PPI remains poor. The Guidance for Reporting Involvement of Patients and the Public (GRIPP2) was developed to enhance the quality and consistency of PPI reporting. The objective of this systematic review is to identify the frequency and quality of PPI reporting in patient safety (PS) research using the GRIPP2 checklist. METHODS Searches were performed in Ovid MEDLINE, EMBASE, PsycINFO, and CINAHL from 2018 to December, 2023. Studies on PPI in PS research were included. We included empirical qualitative, quantitative, mixed methods, and case studies. Only articles published in peer-reviewed journals in English were included. The quality of PPI reporting was assessed using the short form of the (GRIPP2-SF) checklist. RESULTS A total of 8561 studies were retrieved from database searches, updates, and reference checks, of which 82 met the eligibility criteria and were included in this review. Major PS topics were related to medication safety, general PS, and fall prevention. Patient representatives, advocates, patient advisory groups, patients, service users, and health consumers were the most involved. The main involvement across the studies was in commenting on or developing research materials. Only 6.1% (n = 5) of the studies reported PPI as per the GRIPP2 checklist. Regarding the quality of reporting following the GRIPP2-SF criteria, our findings show sub-optimal reporting mainly due to failures in: critically reflecting on PPI in the study; reporting the aim of PPI in the study; and reporting the extent to which PPI influenced the study overall. CONCLUSIONS Our review shows a low frequency of PPI reporting in PS research using the GRIPP2 checklist. Furthermore, it reveals a sub-optimal quality in PPI reporting following GRIPP2-SF items. Researchers, funders, publishers, and journals need to promote consistent and transparent PPI reporting following internationally developed reporting guidelines such as the GRIPP2. Evidence-based guidelines for reporting PPI should be encouraged and supported as it helps future researchers to plan and report PPI more effectively. TRIAL REGISTRATION The review protocol is registered with PROSPERO (CRD42023450715).
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Affiliation(s)
- Sahar Hammoud
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, Health Sciences Centre, University College Dublin, Dublin, Ireland.
| | - Laith Alsabek
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, Health Sciences Centre, University College Dublin, Dublin, Ireland
- Department of Oral and Maxillofacial Surgery, University Hospital Galway, Galway, Ireland
| | - Lisa Rogers
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, Health Sciences Centre, University College Dublin, Dublin, Ireland
| | - Eilish McAuliffe
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, Health Sciences Centre, University College Dublin, Dublin, Ireland
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Sutton E, Booth L, Ibrahim M, McCulloch P, Sujan M, Willars J, Mackintosh N. Am I safe? An Interpretative Phenomenological Analysis of Vulnerability as Experienced by Patients With Complications Following Surgery. QUALITATIVE HEALTH RESEARCH 2022; 32:2078-2089. [PMID: 36321384 PMCID: PMC9709529 DOI: 10.1177/10497323221136956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Abdominal surgery carries with it risks of complications. Little is known about patients' experiences of post-surgical deterioration. There is a real need to understand the psychosocial as well as the biological aspects of deterioration in order to improve care and outcomes for patients. Drawing on in-depth interviews with seven abdominal surgery survivors, we present an idiographic account of participants' experiences, situating their contribution to safety within their personal lived experiences and meaning-making of these episodes of deterioration. Our analysis reveals an overarching group experiential theme of vulnerability in relation to participants' experiences of complications after abdominal surgery. This encapsulates the uncertainty of the situation all the participants found themselves in, and the nature and seriousness of their health conditions. The extent of participants' vulnerability is revealed by detailing how they made sense of their experience, how they negotiated feelings of (un)safety drawing on their relationships with family and staff and the legacy of feelings they were left with when their expectations of care (care as imagined) did not meet the reality of their experiences (care as received). The participants' experiences highlight the power imbalance between patients and professionals in terms of whose knowledge counts within the hospital context. The study reveals the potential for epistemic injustice to arise when patients' concerns are ignored or dismissed. Our data has implications for designing strategies to enable escalation of care, both in terms of supporting staff to deliver compassionate care, and in strengthening patient and family involvement in rescue processes.
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Affiliation(s)
- Elizabeth Sutton
- Department of Health Sciences,
University
of Leicester, Leicester, UK
| | | | - Mudathir Ibrahim
- Nuffield Department of Surgical
Sciences, University of Oxford, Oxford, UK
- Department of General Surgery,
Maimonides
Medical Center, Brooklyn, NY, USA
| | - Peter McCulloch
- Nuffield Department of Surgical
Sciences, University of Oxford, Oxford, UK
| | - Mark Sujan
- Nuffield Department of Surgical
Sciences, University of Oxford, Oxford, UK
- Human Factors Everywhere
Ltd., UK
| | - Janet Willars
- Department of Health Sciences,
University
of Leicester, Leicester, UK
| | - Nicola Mackintosh
- Department of Health Sciences,
University
of Leicester, Leicester, UK
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Gondim ÉS, Gomes EB, Matos JHFD, Pinto SDL, Oliveira CJD, Alencar AMPG. Technologies used by nursing to predict clinical deterioration in hospitalized adults: a scoping review. Rev Bras Enferm 2022; 75:e20210570. [PMID: 35920514 DOI: 10.1590/0034-7167-2021-0570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 04/12/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to map the early clinical deterioration technologies used in nurses' professional practice in the care of hospitalized adult patients. METHODS this is a scoping review, according to Joanna Briggs Institute Reviewer's Manual, which seeks to map the main technologies for detecting early clinical deterioration of hospitalized patients available for use by nurses, summarizing them and indicating gaps in knowledge to be investigated. RESULTS twenty-seven studies were found. The most present variables in the technologies were vital signs, urinary output, awareness and risk scales, clinical examination and nurses' judgment. The main outcomes were activation of rapid response teams, death, cardiac arrest and admission to critical care units. FINAL CONSIDERATIONS the study emphasizes the most accurate variables in patient clinical assessment, so that indicative signs of potential severity can be prioritized to guide health conducts aiming to intervene early in the face of ongoing clinical deterioration.
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Albutt A, Roland D, Lawton R, Conner M, O’Hara J. Capturing Parents' Perspectives of Child Wellness to Support Identification of Acutely Unwell Children in the Emergency Department. J Patient Saf 2022; 18:410-414. [PMID: 35948290 PMCID: PMC9329037 DOI: 10.1097/pts.0000000000000949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Early signs of serious illness can be difficult to recognize in children and a delayed response can result in poor outcomes. Drawing on the unique knowledge of parents and carers may improve identification of the deteriorating child. However, there is a lack of evidence exploring parental perspectives as part of track and trigger systems. This study examines the utility of capturing parent-reported child wellness, using the Patient Wellness Questionnaire for Pediatrics, to support identification of acutely unwell children presenting to the Emergency Department. METHODS Parent-reported child wellness was recorded alongside the Pediatric Observation Priority Score (POPS), a multidimensional scoring system akin to a Pediatric Early Warning Score, used as part of routine care. Multiple linear regression assessed the independent effects of 3 variables (parent-reported child wellness, nurse concern, and child age) on POPS and hospital admission. RESULTS Data were collected for 407 children. All 3 variables explained a statistically significant proportion of variance in POPS (F(3, 403) = 7.525, P < 0.001, R2 = 0.053), with parent-reported child wellness (B = 0.223, SE = 0.054, β = 0.202, P < 0.001) having the strongest effect. Approximately 10% of the children with no physiological derangement were rated as "very poorly" by their parents. CONCLUSIONS The findings suggest that parents have insight in to the wellness of their children that is reflected in the physiological assessment. Some parents' perceptions about their child's wellness were not consistent with the score captured in the same assessment. More work is needed to understand how to use and address parental perspectives and concerns to support clinical decision making and the management of acute illness.
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Affiliation(s)
- Abigail Albutt
- From the Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford
| | - Damian Roland
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Children’s Emergency Department, Leicester Royal Infirmary, Leicester
- SAPPHIRE Group, University of Leicester, Leicester
| | - Rebecca Lawton
- From the Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford
- School of Psychology, University of Leeds, Leeds
| | - Mark Conner
- School of Psychology, University of Leeds, Leeds
| | - Jane O’Hara
- From the Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford
- School of Healthcare, University of Leeds, Leeds, United Kingdom
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8
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Gondim ÉS, Gomes EB, Matos JHFD, Pinto SDL, Oliveira CJD, Alencar AMPG. Tecnologias utilizadas pela enfermagem para predição de deterioração clínica em adultos hospitalizados: revisão de escopo. Rev Bras Enferm 2022. [DOI: 10.1590/0034-7167-2021-0570pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo: mapear as tecnologias de deterioração clínica precoce utilizadas na prática profissional do enfermeiro na assistência a pacientes adultos hospitalizados. Métodos: trata-se de scoping review, segundo Joanna Briggs Institute Reviewer’s Manual, que busca o mapeamento das principais tecnologias para detecção de deterioração clínica precoce de pacientes hospitalizados disponíveis de uso do enfermeiro, sumarizando-as e indicando lacunas no conhecimento a serem investigadas. Resultados: foram encontrados 27 estudos. As variáveis mais presentes nas tecnologias foram sinais vitais, débito urinário, escalas de consciência e riscos, exame clínico e julgamento do enfermeiro. Os principais desfechos foram acionamento de times de resposta rápida, morte, parada cardiorrespiratória e admissão em unidades de cuidados críticos. Considerações finais: o estudo enfatiza as variáveis mais acuradas na avaliação clínica do paciente, para que se possam priorizar sinais indicativos de potencial gravidade para guiar condutas em saúde visando intervir precocemente diante da deterioração clínica em curso.
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Bucknall T, Quinney R, Booth L, McKinney A, Subbe CP, Odell M. When patients (and families) raise the alarm: Patient and family activated rapid response as a safety strategy for hospitals. Future Healthc J 2021; 8:e609-e612. [PMID: 34888450 DOI: 10.7861/fhj.2021-0134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Patients and those close to them often have an intimate understanding of their condition and can participate in a broad range of clinical processes. During times of deterioration, their concerns might go unheard. Advocacy of family and friends can fulfil an important safety function and can support patients and healthcare professionals looking after them. If concerns by patients are not heard by the patient's primary team in hospital, patient and family activated rapid response systems allow patients and family members to alert critical care outreach teams directly. These types of systems are stipulated by regulators in Australia and in parts of the USA, and there are examples in the UK built around the 'Call for Concern' model championed by the Royal Berkshire Hospital. Implementation is not without its problems and requires a deep understanding of barriers and enablers. Empowering patients to escalate directly might help to change safety culture and have protective effects for patients and staff. Policy makers are urged to consider standardised regulation to aid implementation.
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Affiliation(s)
- Tracey Bucknall
- Alfred Health, Melbourne Australia and director, Centre for Quality and Patient Safety Research, Burwood, Australia
| | - Rett Quinney
- Australian Catholic University, Ballarat, Australia
| | - Lisa Booth
- East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | | | - Christian P Subbe
- Ysbyty Gwynedd, Bangor, UK, senior clinical lecturer, Bangor University, Bangor, UK and improvement science fellow, The Health Foundation, London, UK
| | - Mandy Odell
- Royal Berkshire NHS Foundation Trust, Reading, UK
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King L, Ullah S, Belan I, Clark RA, Young T, Grantham H, Peacock G, Kidd MR. Development and Validation of an Evaluation Tool of Consumers' Knowledge and Confidence to Report Patient Deterioration in Hospitals. J Patient Saf 2021; 17:e1406-e1412. [PMID: 34508043 DOI: 10.1097/pts.0000000000000895] [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: 11/26/2022]
Abstract
OBJECTIVES Studies have shown that many preventable hospital deaths may be reduced through early reporting of deterioration by patients and their visitors to health professionals. Engagement of patients and families for safer health care was recommended by the World Health Organization. As no validated tool was identified, the objective of the study was to develop and validate a tool to measure the impact of messages contained in self-developed educational materials on consumers' knowledge and confidence to report patient deterioration. METHODS A tool was created using consumer-based input. A test-retest methodology was used 2 weeks apart, using 37 participants sourced from consumer groups. Fourteen 5-point Likert scale questionnaire items were categorized into knowledge and confidence components to identify the impact of the materials in both of these areas. RESULTS Test-retest reliability confirmed 10 of the 14 proposed questionnaire items (4 knowledge items and 6 confidence) had at least moderate κ agreement ranging from 0.42 to 0.69 and an intraclass correlation coefficient of 0.66. An exploratory factor analysis of the 10 remaining items indicated a 2-factor solution had the best interpretability accounting for 96.9% of variability. The Cronbach α and factor loadings for the factors, knowledge, and confidence suggested an acceptable level of reliability and validity. CONCLUSIONS The study confirms our tool for assessment of educational materials to be a reliable, context-specific, and validated instrument. The tool is an appropriate instrument to assess the effectiveness of educational materials in public awareness campaigns that focus on consumer reporting of patient deterioration within hospitals.
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Affiliation(s)
- Lindy King
- From the College of Nursing and Health Sciences, Flinders University, Adelaide
| | - Shahid Ullah
- College of Medicine and Public Health, Flinders University
| | - Ingrid Belan
- From the College of Nursing and Health Sciences, Flinders University, Adelaide
| | - Robyn A Clark
- College of Nursing and Health Sciences, Caring Futures Institute
| | - Tom Young
- College of Humanities, Arts and Social Sciences, Flinders University, Adelaide, South Australia
| | - Hugh Grantham
- South Australian Ambulance Service/School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia
| | - Guy Peacock
- Division of Mental Health Services, Southern Adelaide Local Health Network (SALHN), Daw Park, South Australia
| | - Michael R Kidd
- The Australian National University, Canberra, Australian Capital Territory, Australia
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11
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Thiele L, Flabouris A, Thompson C. Acute clinical deterioration and consumer escalation in the hospital setting: A literature review. Resuscitation 2020; 156:72-83. [PMID: 32858153 DOI: 10.1016/j.resuscitation.2020.08.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 07/23/2020] [Accepted: 08/09/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Consumer escalation systems that allow patients and/or their family/carers to escalate concerns about clinical deterioration have been proposed as a way of enhancing patient safety. However, evidence to guide implementation or to support system effectiveness remains unclear. AIM To critically evaluate the current evidence surrounding consumer escalation within the context of clinical deterioration to identify the strengths, weaknesses and gaps in existing knowledge, essential themes, and directions for further investigation. METHOD Database searches were conducted within Cumulative Index of Nursing and Allied Health Literature, PubMed, and the Cochrane Library for articles directly relating to consumer escalation systems published, in English, within the previous 10 year-period. Titles and abstracts were screened and relevant full-text articles included. Content was examined to identify breadth of knowledge, essential themes, and the effectiveness of current systems. RESULTS 27 articles, containing a mixture of both quantitative and qualitative findings, were identified. Within the context of limitations in the overall depth and quality of current evidence, four key areas (relating to consumer understanding and awareness of clinical deterioration, confidence and ability to escalate concerns, education, and staff attitudes) were identified as potentially critical to the foundation, functioning, and success of consumer escalation systems. Consumer escalation processes may contribute positive effects beyond mortality rates; however, an agreed method of assessing effectiveness remains undetermined. CONCLUSIONS The ability of consumer escalation processes to achieve their underlying goals is still to be adequately assessed. Further research is required to inform how to best implement, support and optimise consumer escalation systems.
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Affiliation(s)
- Lisa Thiele
- The University of Adelaide, Faculty of Health and Medical Sciences, Adelaide Medical School, North Terrace, Adelaide 5000, South Australia, Australia; Registered Nurse, Intensive Care Unit, Royal Adelaide Hospital, Adelaide 5000, South Australia, Australia.
| | - Arthas Flabouris
- Staff Specialist, Intensive Care Unit, Royal Adelaide Hospital, and Clinical Associate Professor, The University of Adelaide, Faculty of Health and Medical Sciences, Adelaide Medical School, North Terrace, Adelaide 5000, South Australia, Australia.
| | - Campbell Thompson
- Consultant, Acute Medical Unit, Royal Adelaide Hospital, and Professor of Medicine, The University of Adelaide, Faculty of Health and Medical Sciences, Adelaide Medical School, Discipline of Medicine, North Terrace, Adelaide 5000, South Australia, Australia.
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