Patient and/or family activated rapid response service: Patients’ perceptions of deterioration and need for a service

Strickland, Wharewaina; Pirret, Alison; Takerei, Susan

doi:10.1016/j.iccn.2018.11.007

Cited by 27 publications

(59 citation statements)

References 19 publications

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“…The evaluation highlighted that patients are willing and able to give information about changes in wellness when asked and identified that the intervention helped uncover patient concerns that related to communication failure with staff. This finding resonates with other papers which indicate that some patients are aware of deterioration and report lack of communication about concerns as a key reason for escalating care (Albutt et al, 2017;Strickland et al, 2019).…”

supporting

confidence: 87%

Commentary: Involving patients in recognising clinical deterioration in hospital using the Patient Wellness Questionnaire: A mixed-methods study

McKinney

2019

Journal of Research in Nursing

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supporting

confidence: 87%

Commentary: Involving patients in recognising clinical deterioration in hospital using the Patient Wellness Questionnaire: A mixed-methods study

McKinney

2019

Journal of Research in Nursing

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“…Another US evaluation echoed these findings and added that family initiated escalation of care occurred when patients were less severely unwell compared with clinician escalation of care. 10 The involvement of families in recognition of and response to clinical deterioration appears to promote more timely escalation of care, yet a growing number of reports about communication concerns 11,12 emphasize the need for deeper examination beyond the number and nature of calls by families. 13 The involvement of families in safety, especially in escalating care for clinical deterioration, is recognized as complex and difficult to achieve in practice.…”

Section: Introductionmentioning

confidence: 99%

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

Gill

Leslie

Marshall

2019

Health Expectations

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Objective To evaluate the implementation of an intervention for parents to escalate care if concerned about their child's clinical condition. Design Mixed‐methods health‐care improvement approach guided by the Theoretical Domains Framework. Methods Implementation of the ‘Calling for Help’ (C4H) intervention was informed by previously identified barriers and facilitators. Evaluation involved audit, review of clinical deterioration incidents, interviews and focus groups. Setting Australian specialist paediatric hospital. Participants Convenience sample of 75 parents from inpatient areas during the audit, interviews with ten parents who had expressed concern about their child's clinical condition; five focus groups with 35 ward nurses. Main outcome measures Parent awareness and utilization of C4H, parent and nurse views of factors influencing implementation. Results Parent awareness of C4H improved to 35% (25/75). Parent concern was documented prior to 21/174 (12%) clinical deterioration events. All interviewed parents and nurses who participated in focus groups were positive about C4H. Parents preferred to be informed about C4H by nurses, but nurses described this as time‐consuming and selectively chose parents who they believed would benefit most. Parents and nurses described frustrations with and trepidation in escalating care. Nurses had used C4H to expedite urgent medical review. Conclusions There was an improvement in the level of parent awareness of C4H, which was viewed positively by parents and nurses alike. To achieve a high level of parent awareness in a sustainable way, a multifaceted approach is required. Further strategies will be required for parents to feel confident enough to use C4H and to address interprofessional communication barriers.

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“…Study design included: two qualitative, exploratory design studies 35,36 ; one qualitative cross‐sectional design study 37 ; one interpretive qualitative research design study 38 ; and one retrospective chart review with qualitative data 39 . One study was conducted in the UK, 35 three in Australia 36,38,39 and one in New Zealand 37 . Study characteristics are summarised in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…Participants (patients, relatives, healthcare professionals) were mainly recruited from acute adult medical or surgical wards in large metropolitan or regional hospitals in high‐income countries 35–37 . One study recruited from community‐based consumer organisations, 38 who had experiences of being patients or family members of past patients in acute hospitals.…”

Section: Resultsmentioning

confidence: 99%

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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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Patient and/or family activated rapid response service: Patients’ perceptions of deterioration and need for a service

Cited by 27 publications

References 19 publications

Commentary: Involving patients in recognising clinical deterioration in hospital using the Patient Wellness Questionnaire: A mixed-methods study

Commentary: Involving patients in recognising clinical deterioration in hospital using the Patient Wellness Questionnaire: A mixed-methods study

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

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

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