The effectiveness of a patient at risk team comprised of predominantly ward experienced nurses: A before and after study

Pirret, Alison; Takerei, Susan; Kazula, Lesley M.

doi:10.1016/j.iccn.2014.10.005

Cited by 14 publications

(27 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Three studies only recorded patient length of stay as an outcome – Pirret () and Pirret et al . () both reported that the introduction of an NL‐CCOS decreased patient length of stay. Priestley et al .…”

Section: Resultsmentioning

confidence: 95%

Do nurse‐led critical care outreach services impact inpatient mortality rates?

Garry

Rohan

O’Connor

et al. 2018

Nursing in Critical Care

View full text Add to dashboard Cite

Background: Previous systematic reviews have assessed the effect of critical care outreach services, but none have focused solely on nurse-led services. Aim: To perform a systematic review examining the impact of nurse-led critical care outreach services on inpatient mortality rates as the primary outcome. Secondary outcomes include arrest call rates and patient length of stay. Methods: A comprehensive search of several electronic databases was carried out, including the Cumulative Index to Nursing and Allied Health Literature and Medline. Non-catalogued literature was searched, and contact was made by e-mail with expert authors. All studies were in the English language, and although heterogeneous in design, only quantitative data were extracted for analysis. All included studies were assessed for quality using recognized quality appraisal tools. Meta-analysis was not possible because of heterogeneity. Results: Ten studies involving almost 72 000 participants were identified. The reduction in mortality rates with nurse-led critical care outreach services was reported to be 80%, but the statistical significance was low -four studies showed reductions ranging from 0⋅1% to 0⋅22%. Greater statistical significance was reported in arrest call rates, with two studies claiming decreased rates of 58⋅7% and 29⋅6%. Two studies reported a decrease in patient length of stay -the findings of a third study were equivocal. Half of the included studies scored poorly in terms of quality and validity, and all were single-centre studies, thereby limiting generalisability. Conclusion: Nurse-led critical care outreach services demonstrate benefits in terms of patient care and reduction in adverse events. Higher-quality research, including multicentre randomized controlled trials, with meta-analysis is recommended. Relevance to clinical practice: Nurse-led critical care outreach services have the potential to improve patient outcomes. Uniformity of team composition and nomenclature would benefit data collection and reporting.

show abstract

Section: Resultsmentioning

confidence: 95%

Do nurse‐led critical care outreach services impact inpatient mortality rates?

Garry

Rohan

O’Connor

et al. 2018

Nursing in Critical Care

View full text Add to dashboard Cite

show abstract

“…Two studies evaluated medically led teams, 77,80 and two evaluated nurse-led teams. 76,81 All studies also introduced either a NEWS or altered the escalation criteria for an existing scoring system. Both of the uncontrolled before-and-after studies reported a reduction in cardiac arrest rates and one also found a reduction in mortality.…”

Section: Data Synthesis and Analysismentioning

confidence: 99%

Interventions to reduce mortality from in-hospital cardiac arrest: a mixed-methods study

Hogan

Hutchings

Wulff

et al. 2019

Health Serv Deliv Res

View full text Add to dashboard Cite

BackgroundUnchecked patient deterioration can lead to in-hospital cardiac arrest (IHCA) and avoidable death. The National Cardiac Arrest Audit (NCAA) has found fourfold variation in IHCA rates and survival between English hospitals. Key to reducing IHCA is both the identification of patients at risk of deterioration and prompt response. A range of targeted interventions have been introduced but implementation varies between hospitals. These differences are likely to contribute to the observed variation between and within hospitals over time.ObjectiveTo determine how interventions aimed at identification and management of deteriorating patients are associated with IHCA rates and outcomes.DesignA mixed-methods study involving a systematic literature review, semistructured interviews with 60 NHS staff, an organisational survey in 171 hospitals and interrupted time series and difference-in-difference analyses (106 hospitals).SettingEnglish hospitals participating in the NCAA audit.ParticipantsNHS staff (approximately 300) and patients (13 million).InterventionsEducation, track-and-trigger systems (TTSs), standardised handover tools and outreach teams.Main outcome measuresIHCA rates, survival and hospital-wide mortality.Data sourcesNCAA, Hospital Episode Statistics, Office for National Statistics Mortality Statistics.MethodsA literature review and qualitative interviews were used to design an organisational survey that determined how interventions have been implemented in practice and across time. Associations between variations in services and IHCA rates and survival were determined using cross-sectional, interrupted time series and difference-in-difference analyses over the index study period (2009/10 to 2014/15).ResultsAcross NCAA hospitals, IHCAs fell by 6.4% per year and survival increased by 5% per year, with hospital mortality decreasing by a similar amount. A national, standard TTS [the National Early Warning Score (NEWS)], introduced in 2012, was adopted by 70% of hospitals by 2015. By 2015, one-third of hospitals had converted from paper-based TTSs to electronic TTSs, and there had been an increase in the number of hospitals with an outreach team and an increase in the number with a team available at all times. The extent of variation in the uses of educational courses and structured handover tools was limited, with 90% of hospitals reporting use of standardised communication tools, such as situation, background, assessment and recommendation, in 2015. Introduction of the NEWS was associated with an additional 8.4% decrease in IHCA rates and, separately, a conversion from paper to electronic TTS use was associated with an additional 7.6% decrease. However, there was no associated change in IHCA survival or hospital mortality. Outreach teams were not associated with a change in IHCA rates, survival or hospital mortality. A sensitivity analysis restricted to ward-based IHCAs did not alter the findings but did identify an association between increased outreach team intensity in 2015 and IHCA survival.LimitationsThe organisational survey was not able to explore all aspects of the interventions and the contextual factors that influenced them. Changes over time were dependent on respondents’ recall.ConclusionsStandardisation of TTSs and introduction of electronic TTSs are associated with a reduction in IHCAs. The apparent lack of impact of outreach teams may reflect their mode of introduction, that their effect is through providing support for implementation of TTS or that the organisation of the response to deterioration is not critical, as long as it is timely. Their role in end-of-life decision-making may account for the observed association with IHCA survival.Future workTo assess the potential impact of outreach teams at hospital level and patient level, and to establish which component of the TTS has the greatest effect on outcomes.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

show abstract

“…When compared to efferent limb RT services, outreach services provided a more proactive interprofessional collaborative system‐wide approach when responding to concerns of clinical deterioration in ward patients, which was consistent with their intended purpose of extending critical care expertise outside of critical care areas (Marsh & Pittard, ). While there appears to be benefits in proactive (afferent limb) assessment teams, such as outreach services, with early identification of patients at risk of deterioration (Pirret et al., ; Wood et al., ), there is still a lack of evidence from a system‐wide perspective to support their effectiveness on improving in‐hospital patient outcomes. While various types of uniquely structured proactive patient safety teams continue to be implemented in acute healthcare organisations, future large‐scale system‐wide research would be beneficial but perhaps not feasible or ethical.…”

Section: Discussionmentioning

confidence: 99%

“…Four ICP themes were grouped under one overarching theme (Table 6) (Marsh & Pittard, 2012). While there appears to be benefits in proactive (afferent limb) assessment teams, such as outreach services, with early identification of patients at risk of deterioration (Pirret et al, 2015;Wood et al, 2009), there is still a lack of evidence from a system-wide perspective to support their effectiveness on improving in-hospital patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…There is currently little evidence to guide recommendations regarding RT staffing composition, except that responses to deterioration are more likely to be effective when a clinician with critical care skills is leading the RT event (McNeill & Bryden, ). Whether RT should be medical specialist‐led (Al‐Qahtani et al., ), primary care team‐led (Howell et al., ; Moldenhauer, Sabel, Chu, & Mehler, ) or nurse specialist‐led (Mitchell, Schatz, & Francis, ; Pirret, Takerei, & Kazula, ) is unclear. Other variations in RT composition occur between organisations according to “individualised” predetermined clinical parameters and recommended responses (Psirides, Hill, & Hurford, ), which again are adapted locally to align with relevant policies protocols and resources (Australian Commission on Safety and Quality in Healthcare ).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation