Rapid response systems and collective (in)competence: An exploratory analysis of intraprofessional and interprofessional activation factors

Abstract

The rapid response system (RRS) is a patient safety initiative instituted to enable healthcare professionals to promptly access help when a patient's status deteriorates. Despite patients meeting the criteria, up to one-third of the RRS cases that should be activated are not called, constituting a "missed RRS call". Using a case study approach, 10 focus groups of senior and junior nurses and physicians across four hospitals in Australia were conducted to gain greater insight into the social, professional and cultural factors that mediate the usage of the RRS. Participants' experiences with the RRS were explored from an interprofessional and collective competence perspective. Health professionals' reasons for not activating the RRS included: distinct intraprofessional clinical decision-making pathways; a highly hierarchical pathway in nursing, and a more autonomous pathway in medicine; and interprofessional communication barriers between nursing and medicine when deciding to make and actually making a RRS call. Participants also characterized the RRS as a work-around tool that is utilized when health professionals encounter problematic interprofessional communication. The results can be conceptualized as a form of collective incompetence that have important implications for the design and implementation of interprofessional patient safety initiatives, such as the RRS.

Recognising and responding to in‐hospital clinical deterioration: An integrative review of interprofessional practice issues

“…Hierarchies were also described to have unique intradisciplinary decision‐making processes to escalate patient care. Nurse decision‐making was described as “highly hierarchical and protocol‐based,” and medical as “autonomous … medicine based on clinical judgement” (Kitto et al., , p. 342), with a perception that nurses tended to over‐activate according to escalation criteria and doctors tended to under‐activate efferent limb responses (C10).…”

To identify the factors that influence the recognizing and responding to adult patient deterioration in acute hospitals

“…Professional relationships between nurses and doctors have long been seen as problematic (Chalwin, Flabouris, Kapitola, & Dewick, ; Chua et al, ; Douglas, Osborne, et al, ; Kitto et al, ; Massey, Chaboyer, & Aiken, ). A qualitative study identified that the perceived hierarchy between the medicine and nursing professional may halter escalation of care (Chua et al, ).…”

Physical deterioration in an acute mental health unit: A quantitative retrospective analysis of medical emergencies

“…The literature, however, has described various barriers to MET calling by nurses owing to the characteristics of the medical-nursing hierarchy, ward protocols, and staff availability, Kitto et al 2015;Chua et al 2017). This calls into question whether all patients with mental illness who exhibit physiological abnormalities are properly assessed by nurses or doctors and whether those who exceed objective scores do receive a MET review.…”