Family-Initiated Pediatric Rapid Response: Characteristics, Impetus, and Outcomes

Bavare, Aarti; Thomas, Jenilea K.; Elliott, Elizabeth; Morgan, Alice; Graf, Jeanine M.

doi:10.1097/jhq.0000000000000096

Cited by 18 publications

(23 citation statements)

References 11 publications

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“…Evaluations to understand the effectiveness of these schemes 15,16 have indicated that on occasions relatives identified deterioration and escalated a number of patients that were undetected by healthcare staff 10,11,17–19 . Studies also identified that they are valued by patients and relatives 11,16,17,20 and are associated with increased feelings of reassurance and patient empowerment 11,13 .…”

Section: Introductionmentioning

confidence: 99%

Patient and family involvement in escalating concerns about clinical deterioration in acute adult wards: A qualitative systematic review

McKinney

Fitzsimons

Blackwood

et al. 2020

Nursing in Critical Care

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Background Despite international standards for recognition and response to deterioration, warning signs are not always identified by staff on acute hospital wards. Patient and family‐initiated escalation of care schemes have shown some benefit in assisting early recognition, but are not widely used in many clinical practice areas. Objectives To explore (a) patients' and relatives' experiences of acute deterioration and (b) patients', relatives' and healthcare professionals' perceptions of the barriers or facilitators to patient and family‐initiated escalation of care in acute adult hospital wards. Methods We conducted a qualitative review using Cochrane methodology. Two reviewers independently screened studies, extracted data, and appraised the quality using a qualitative critical appraisal tool. Findings were analysed using thematic synthesis and confidence in findings was assessed using GRADE‐CERQual. Search strategy MEDLINE, CINAHL, EMBASE, PsychINFO databases and grey literature from 2005 to August 2019. Inclusion criteria Any research design that had a qualitative element and focused on adult patients' and relatives' experiences of deterioration and perceptions of escalating care. Results We included five studies representing 120 participants and assessed the certainty of evidence as moderate using GRADE‐CERQual. Findings indicated that a number of patients/relatives have the ability to detect acute deterioration, however, various factors act as both barriers and facilitators to being heard. These include personal factors, perceptions of role, quality of relationships with healthcare staff, and organisational factors. Theoretical understanding suggests that patient and relative involvement in escalation is dependent on both inherent capabilities and the factors that influence empowerment. Conclusion This review highlights that patient and family escalation of care interventions need to be designed with the aim of improving patient/relative—clinician collaboration and the sharing of responsibility. Relevance to practice These factors need to be addressed to promote more active partnerships when designing and implementing patient and family‐initiated escalation of care interventions.

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Section: Introductionmentioning

confidence: 99%

Patient and family involvement in escalating concerns about clinical deterioration in acute adult wards: A qualitative systematic review

McKinney

Fitzsimons

Blackwood

et al. 2020

Nursing in Critical Care

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“…Confusion also arises from the variety of names that exist for the intervention. Family-initiated escalation of care [37], patient and family-initiated rapid response system [42], patient and relative-activated RRT [41] and family-initiated rapid response [43] are amongst those identified, with some appearing to promote both patient and family escalation [42] and others family escalation only [43]. It is therefore evident that greater clarity is needed in relation to what such systems/interventions should be called and who exactly they are intended for.…”

Section: Introductionmentioning

confidence: 99%

“…A number of evaluations have been carried out to understand how these interventions work in practice. These have focused on identifying the number of patient and family-initiated calls, the reasons for activation and identifying who escalates calls [33, 34, 40, 41, 43, 48, 49]. In the majority of cases, most of the reasons for activating escalation of care were cited as appropriate [36, 50].…”

Section: Introductionmentioning

confidence: 99%

“…In the majority of cases, most of the reasons for activating escalation of care were cited as appropriate [36, 50]. Bavare et al [43] however would argue that there is a paucity of data that currently depicts reasons for which families activate RRT compared with those activated by clinicians. Eden et al [42] also reported that calls tend to relate to non-safety issues and therefore questions the utility of patient and family-activated RRTs and whether they meet their intended purpose.…”

Section: Introductionmentioning

confidence: 99%

“…Evaluations have also sought to understand how effective these schemes are and their impact on patients, relatives, healthcare staff and the overall hospital environment. Evaluation of the schemes noted that relatives escalated a sub-set of patients missed by healthcare staff, identified a vital sign change that should have promoted clinical activation of RRS and a number of patients were transferred to higher dependency areas or received medical intervention on the ward [33, 40, 43, 50]. Findings also indicate that patients and/or families felt reassured when the service was available and reported high satisfaction levels with the schemes and increased feelings of empowerment [33, 34, 41].…”

Section: Introductionmentioning

confidence: 99%

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Patient and family-initiated escalation of care: a qualitative systematic review protocol

McKinney¹,

Fitzsimons²,

Blackwood³

et al. 2019

Syst Rev

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Background Despite the introduction of rapid response systems and early warning scores, clinical deterioration that is not recognised or responded to early enough prevails in acute care areas. One intervention that aims to address this issue and that is gaining increased attention is patient- and family-initiated escalation of care schemes. Existing systematic review evidence to date has tended to focus on identifying the impact or effectiveness of these schemes in practice. However, they have not tended to focus on qualitative evidence to consider the experience of deterioration and the factors that may promote or hinder engagement with these schemes in the practice setting. This systematic review will address this gap. The aim of this review is to explore patients’, relatives’ and healthcare professionals’ experiences of deterioration and their perceptions of the barriers or facilitators to patient and family-initiated escalation of care in acute adult hospital wards. Methods We will search Medline, CINAHL, Embase and PsycINFO databases using free-text and MESH terms relating to deterioration, family-initiated rapid response, families, patients, healthcare staff, hospital and experiences. We will search grey literature and reference lists of included studies for further published and unpublished literature. All studies with a qualitative design or method will be included. Two reviewers will independently assess studies for eligibility, extract data and appraise the quality of included studies. Data will be synthesised using a thematic synthesis approach, and findings will be presented narratively. Discussion Patient- and family-initiated escalation of care schemes have been developed and implemented in several countries including the United States, the United Kingdom and Australia, but there is limited evidence regarding patients’ or families’ perceptions of deterioration or the barriers and facilitators to using these schemes in practice, particularly in acute adult areas. This systematic review will provide evidence for the development of a patient and family escalation of care scheme that can be tested in a feasibility study. Systematic review registration PROSPERO CRD42018106952 Electronic supplementary material The online version of this article (10.1186/s13643-019-1010-z) contains supplementary material, which is available to authorized users.

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Safety in Children With Medical Complexity: Our Canaries in the Coal Mine?

Schindler

Pordes

Finkenbinder³

et al. 2019

Curr Treat Options Peds

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Family-Initiated Pediatric Rapid Response: Characteristics, Impetus, and Outcomes

Cited by 18 publications

References 11 publications

Patient and family involvement in escalating concerns about clinical deterioration in acute adult wards: A qualitative systematic review

Patient and family involvement in escalating concerns about clinical deterioration in acute adult wards: A qualitative systematic review

Patient and family-initiated escalation of care: a qualitative systematic review protocol

Safety in Children With Medical Complexity: Our Canaries in the Coal Mine?

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