Patient perceptions of deterioration and patient and family activated escalation systems—A qualitative study

Guinane, Jessica; Hutchinson, Alison M.; Bucknall, Tracey

doi:10.1111/jocn.14202

Cited by 22 publications

(63 citation statements)

References 47 publications

(60 reference statements)

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“…Norms of passivity, language and health literacy have been described to influence patient and family's willingness and ability to actively speak up in similar situations. It has also been suggested that families' reticence to speak up is associated with confidence and familiarity with the health‐care system . In this study, difficulty speaking up was also described by parents who were themselves highly health literate health professionals who wanted to avoid conflict with colleagues.…”

Section: Discussionmentioning

confidence: 74%

“…It has also been suggested that families' reticence to speak up is associated with confidence and familiarity with the health-care system. 12,15 In this study, difficulty speaking up was also described by parents who were themselves highly health literate health professionals who wanted to avoid conflict with colleagues. At this point, no specific strategies had been used to address the barrier of overcoming the traditional hospital hierarchy which remains a widely reported issue in escalation of care.…”

Section: Thismentioning

confidence: 91%

“…The involvement of families in safety, especially in escalating care for clinical deterioration, is recognized as complex and difficult to achieve in practice . The ‘complexity’ itself relates to the several interacting components within the intervention and also the interaction of the intervention with the health‐care context .…”

Section: Introductionmentioning

confidence: 99%

“…13 The involvement of families in safety, especially in escalating care for clinical deterioration, is recognized as complex and difficult to achieve in practice. 14,15 The 'complexity' itself relates to the several interacting components within the intervention and also the interaction of the intervention with the health-care context. 16 Health-care improvement is a term used to describe a systematic approach to increase the quality, safety and value of health-care services.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 74%

Section: Thismentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…Five qualitative studies were included in the review, consisting of the experiences of 88 patients and 32 relatives reported in four studies 35–38 . One study 39 reported on the experiences and views of patients, relatives, and healthcare staff, however, did not clearly report on the sample size from each group (n = 56).…”

Section: The Reviewmentioning

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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Evaluation of a patient and family activated escalation system: Ryan's Rule

Dwyer

Flenady

Kahl

et al. 2020

Australian Critical Care

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Patient perceptions of deterioration and patient and family activated escalation systems—A qualitative study

Cited by 22 publications

References 47 publications

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

Evaluation of a patient and family activated escalation system: Ryan's Rule

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