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Factors influencing the activation of the rapid response system for clinically deteriorating patients by frontline ward clinicians: a systematic review.

ABSTRACT: Purpose:To synthesize factors influencing the activation of the rapid response system (RRS) and reasons for suboptimal RRS activation by ward nurses and junior physicians. Data sources:Nine electronic databases were searched for articles published between January 1995 and January 2016 in addition to a hand-search of reference lists and relevant journals. Study selection:Published primary studies conducted in adult general ward settings and involved the experiences and views of ward nurses and/or junior physicians in RRS activation were included. Data extraction:Data on design, methods and key findings were extracted and collated. Results of data synthesis:Thirty studies were included for the review. The process to RRS activation was influenced by the perceptions and clinical experiences of ward nurses and physicians, and facilitated by tools and technologies, including the sensitivity and specificity of the activation criteria, and monitoring technology. However, the task of enacting the RRS activations was challenged by seeking further justification, deliberating over reactions from the rapid response team and the impact of workload and staffing. Finally, adherence to the traditional model of escalation of care, support from colleagues and hospital leaders, and staff training were organizational factors that influence RRS activation. Conclusion:This review suggests that the factors influencing RRS activation originated from a combination of socio-cultural, organizational and technical aspects. Institutions that strive for improvements in the existing RRS or are considering to adopt the RRS should consider the complex interactions between people and the elements of technologies, tasks, environment and organization in healthcare settings.

SUBMITTER: Chua WL

PROVIDER: S-EPMC6216047 | biostudies-literature | 2017 Dec

REPOSITORIES: biostudies-literature

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Factors influencing the activation of the rapid response system for clinically deteriorating patients by frontline ward clinicians: a systematic review.

Chua Wei Ling WL See Min Ting Alicia MTA Legio-Quigley Helena H Jones Daryl D Tee Augustine A Liaw Sok Ying SY

International journal for quality in health care : journal of the International Society for Quality in Health Care 20171201 8

<h4>Purpose</h4>To synthesize factors influencing the activation of the rapid response system (RRS) and reasons for suboptimal RRS activation by ward nurses and junior physicians.<h4>Data sources</h4>Nine electronic databases were searched for articles published between January 1995 and January 2016 in addition to a hand-search of reference lists and relevant journals.<h4>Study selection</h4>Published primary studies conducted in adult general ward settings and involved the experiences and views ...[more]

PMID: 29177454

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Project description:ImportanceIt is unknown which deteriorating ward patients benefit from intensive care unit (ICU) transfer.ObjectivesTo use an instrumental variable (IV) method that assesses heterogeneity and to evaluate estimates of person-centered treatment effects of ICU transfer and 28-day hospital mortality by age and illness severity.Design, setting, and participantsAn analysis of a prospective cohort study from November 1, 2010, to December 31, 2011. The dates of this analysis were June 1, 2017, to June 30, 2018. The setting was a multicenter study of 49 UK National Health Service hospitals. Participants were 9192 deteriorating ward patients assessed for ICU transfer (4596 matched pairs). The study matched on baseline characteristics to strengthen the IV and to balance observed confounders between the comparison groups.ExposuresTransfer to the ICU or continued care on general wards.Main outcomes and measuresMortality at 28 days (primary outcome) and 90 days. To address unobserved confounding, ICU bed availability was the IV for whether or not a patient was transferred. The study used the IV approach to evaluate estimates of treatment effect of ICU transfer and mortality according to age and physiological severity alone and in combination.ResultsBoth comparison groups included 4596 patients. In the group assessed with "many" ICU beds available (median, 7), 52.8% were male, and the mean (SD) age was 65.2 (17.7) years; in the group assessed with "few" ICU beds available (median, 2), 53.3% were male, and the mean (SD) age was 65.0 (17.3) years. The overall 28-day mortality estimates were 23.2% (2090 predicted deaths) if all of the matched patients were transferred vs 28.1% (2534 predicted deaths) if none of the matched patients were transferred, an estimated risk difference of -4.9% (95% CI, -26.4% to 16.6%). The estimated effects of ICU transfer differed by age and by physiological severity according to the National Early Warning Score (NEWS): the absolute risk differences in 28-day mortality after ICU transfer ranged from 7.7% (95% CI, -5.5% to 21.0%) for ages 18 to 23 years to -5.0% (95% CI -26.5% to 16.6%) for age 78 to 83 years and ranged from 3.7% (95% CI, -12.1% to 19.5%) for NEWS of 0 to -25.4% (95% CI, -50.6% to -0.2%) for NEWS of 19. The absolute risk differences for elderly patients (≥75 years) were -11.6% (95% CI, -39.0% to 15.8%) for those with high NEWS (>6), -4.8% (95% CI, -30.5% to 20.9%) for those with moderate NEWS (5-6), and -1.0% (95% CI, -24.8% to 22.8%) for those with low NEWS (<5). The corresponding estimates for subgroups of younger patients (<75 years) were -8.4% (95% CI, -31.0% to 14.1%), -2.1% (95% CI, -21.1% to 16.9%), and 1.4% (95% CI, -14.5% to 17.4%).Conclusions and relevanceThis study using a this person-centered IV approach found that the benefits of ICU care may increase among patients at high levels of baseline physiological severity across different age groups, especially among elderly patients.

Project description:BackgroundMeasurement-based care (MBC) is the practice of routinely administering standardized measures to support clinical decision-making and monitor treatment progress. Despite evidence of its effectiveness, MBC is rarely adopted in routine substance use disorder (SUD) treatment settings and little is known about the factors that may improve its adoptability in these settings. The current study gathered qualitative data from SUD treatment clinicians about their perceptions of MBC, the clinical outcomes they would most like to monitor in MBC, and suggestions for the design and implementation of MBC systems in their settings.MethodsFifteen clinicians from one publicly-funded and two privately-funded outpatient SUD treatment clinics participated in one-on-one research interviews. Interviews focused on clinicians' perceived benefits, drawbacks, and ideas related to implementing MBC technology into their clinical workflows. Interviews were audio recorded, transcribed, and coded to allow for thematic analysis using a mixed deductive and inductive approach. Clinicians also completed a card sorting task to rate the perceived helpfulness of routinely measuring and monitoring different treatment outcomes.ResultsClinicians reported several potential benefits of MBC, including improved patient-provider communication, client empowerment, and improved communication between clinicians. Clinicians also expressed potential drawbacks, including concerns about subjectivity in patient self-reports, limits to personalization, increased time burdens, and needing to learn to use new technologies. Clinicians generated several ideas and preferences aimed at minimizing burden of MBC, illustrating clinical changes over time, improving ease of use, and improving personalization. Numerous patient outcomes were identified as "very helpful" to track, including coping skills, social support, and motivation for change.ConclusionsMBC may be a beneficial tool for improving clinical care in SUD treatment settings. MBC tools may be particularly adoptable if they are compatible with existing workflows, help illustrate gradual and nonlinear progress in SUD treatment, measure outcomes perceived as clinically useful, accommodate multiple use cases and stakeholder groups, and are framed as an additional source of information meant to augment, rather than replace, existing practices and information sources.

Dataset Information

Factors influencing the activation of the rapid response system for clinically deteriorating patients by frontline ward clinicians: a systematic review.

Publications

Factors influencing the activation of the rapid response system for clinically deteriorating patients by frontline ward clinicians: a systematic review.

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