Clinical Utility of an Observation and Response Chart With Human Factors Design Characteristics and a Track and Trigger System: Study Protocol for a Two-Phase Multisite Multiple-Methods Design

Abstract

BackgroundClinical deterioration of adult patients in acute medical-surgical wards continues to occur, despite a range of systems and processes designed to minimize this risk. In Australia, a standardized template for adult observation charts using human factors design principles and decision-support characteristics was developed to improve the detection of and response to abnormal vital signs.ObjectiveTo describe the study protocol for the clinical testing of these observation and response charts (ORCs).MethodsWe propose a two-phase multisite multiple-methods design to test the initial clinical utility of the charts in 10 hospitals of differing types and sizes across state jurisdictions in Australia. Data collection in the first phase includes user surveys, observations and field notes by project officers, handover de-briefs (short interviews with small groups of staff), and an audit of ORC documentation completion compared to the site’s existing observation chart. For the second phase, data will be collected using a retrospective audit of observation documentation from the previous hospital observation chart, prospective audit of observation documentation following implementation of the selected ORC, user focus groups, observational field notes, and patient outcome data from routinely collected organizational data sources.ResultsSite selection and preparation, project officer training, chart selection and implementation, participant recruitment, and data collection has been completed and the analysis of these results are in progress.ConclusionsThis detailed description of these study methods and data collection approaches will enable a comprehensive assessment of the clinical utility of these newly developed track and trigger charts and will be useful for clinicians and researchers when planning and implementing similar studies. Potential methodological limitations are also noted.

Clinical user experiences of observation and response charts: focus group findings of using a new format chart incorporating a track and trigger system

“…Interventions in response to abnormal observations are also recorded in a designated section of the chart. Further details about the chart format and design characteristics are available 31 32…”

“…The study reported here formed part of a larger two-phase multisite before–after mixed-methods study32 examining the clinical use and application of the ORCs in adult general acute medical-surgical wards.…”

User acceptance of observation and response charts with a track and trigger system: a multisite staff survey

“…Further description of the chart structure is reported elsewhere (Elliott et al . ), and chart examples are provided in Supporting information.…”

“…Charts were formatted as an A3-sized double-sided booklet with a left binding margin and a fold from the right. Further description of the chart structure is reported elsewhere (Elliott et al 2014), and chart examples are provided in Supporting information.…”

Observation chart design features affect the detection of patient deterioration: a systematic experimental evaluation

“…In recent years, clinicians and researchers in Australia and the UK have created new charts with this precise objective in mind and have employed several techniques to examine the effects of chart design on the detection of patient deterioration, including: prospective before-andafter controlled intervention trials (Mitchell et al 2010); comparative clinical evaluations (Chatterjee et al 2005, Elliott et al 2014; and behavioural experiments (Preece et al 2012a, Christofidis et al 2013, Fung et al 2014. In each of these studies, the performance of chart-users (including nurses) was compared across two or more charts and, in almost all cases, designs that included early-warning scoring-systems yielded the best results.…”