Is there a role for patients and their relatives in escalating clinical deterioration in hospital? A systematic review

Abstract

BackgroundMeasures exist to improve early recognition of, and response to, deteriorating patients in hospital. However, deteriorating patients continue to go unrecognized. To address this, interventions have been developed that invite patients and relatives to escalate patient deterioration to a rapid response team (RRT).ObjectiveTo systematically review articles that describe these interventions and investigate their effectiveness at reducing preventable deterioration.Search strategyFollowing PRISMA guidelines, four electronic databases and two web search engines were searched to identify literature investigating patient and relative led escalation.Inclusion criteriaArticles investigating the implementation or use of systems involving patients and relatives in the detection of clinical patient deterioration and escalation of patient care to address any clinical or non‐clinical outcomes were included. Articles’ eligibility was validated by a second reviewer (20%).Data extractionData were extracted according to pre‐defined criteria.Data synthesisNarrative synthesis was applied to included studies.Main resultsNine empirical studies and 36 grey literature articles were included in the review. Limited studies were conducted to establish the clinical effectiveness of patient and relative led escalation. Instead, studies investigated the impact of this intervention on health‐care staff and available resources. Although appropriate, this reflects the infancy of research in this area. Patients and relatives did not overwhelm resources by activating the RRT. However, they did activate it to address concerns unrelated to patient deterioration.ConclusionsActivating a RRT may not be the most appropriate or cost‐effective method of resolving non‐life‐threatening concerns.

Barriers and facilitators to implementing a process to enable parent escalation of care for the deteriorating child in hospital

“…Further supporting the concept of parent escalation of care, there was agreement C4H provided an added safety net for early recognition of deterioration that parents can recognize what is not normal for their child and can notice subtle changes that nurses and doctors may not detect . This parent role has yet to be evaluated in practice …”

“…How family involvement in Rapid Response Systems has been implemented and evaluated in the USA and UK context was the focus of three recent reviews. Evaluations reported uniformly positive family satisfaction .…”

Patient and family engagement as a potential approach for improving patient safety: A systematic review

“…Numerous original studies have yielded multidimensional findings regarding diverse aspects of PFE in patient safety, such as the effects of PFE interventions on specific types of adverse events (Cox et al, ; Davis, Sevdalis, Pinto, Darzi, & Vincent, ; Jha et al, ), factors affecting PFE (Larsson, Sahlsten, Segesten, & Plos, ; Martin, Navne, & Lipczak, ; Mohsin‐Shaikh, Garfield, & Franklin, ), benefits and harms of PFE (Etchegaray et al, ; Latimer, Chaboyer, & Gillespie, ; Weingart et al, ) and perspectives of HCPs and PFs (Latimer et al, ; Skagerström, Ericsson, Nilsen, Ekstedt, & Schildmeijer, ). Several reviews have attempted to address information overload and the inconsistent results of these studies, but they have mostly focused on specific issues such as the role of PFs in patient safety (Albutt, O'Hara, Conner, Fletcher, & Lawton, ) and factors influencing PFE implementation (Berger, Flickinger, Pfoh, Martinez, & Dy, ; Hall et al, ; Longtin et al, ; Trier, Valderas, Wensing, Martin, & Egebart, ). Only one comprehensive review has employed data searching and that was performed back in 2008 (Schwappach, ).…”

Parent escalation of care for the deteriorating child in hospital: A health‐care improvement study

“…Despite these initiatives being widely publicized, there remain few reports about their implementation or evaluation. Three reviews found 14 reports describing implementation of family escalation of care processes in the United States of America (US) and United Kingdom (UK) contexts. Key findings were that family feedback was uniformly positive, and in particular, families were happy that there was a process in place for them to voice concerns irrespective of whether or not they initiated escalation of care .…”