User acceptance of observation and response charts with a track and trigger system: a multisite staff survey

Abstract

Aims and objectives. To examine user acceptance with a new format of charts for recording observations and as a prompt for responding to episodes of clinical deterioration in adult medical-surgical patients. Background. Improving recognition and response to clinical deterioration remains a challenge for acute healthcare institutions globally. Five chart templates were developed in Australia, combining human factors design principles with a track and trigger system for escalation of care. Two chart templates were previously tested in simulations, but none had been evaluated in clinical practice. Design. Prospective multisite survey of user acceptance of the charts in practice. Methods. New observation and response charts were trialled in parallel with existing charts for 24 hours across 36 adult acute medical-surgical wards, covering 108 shifts, in five Australian states. Surveys were completed by 477 staff respondents, with open-ended comments and narrative from short informal feedback groups providing elaboration and context of user experiences. Results. Respondents were broadly supportive of the chart format and content for monitoring patients, and as a prompt for escalating care. Some concerns were noted for chart size and style, use of ranges to graph vital signs and with specific human factors design features. Information and training issues were identified to improve usability and adherence to chart guidelines and to support improved detection and response for patients with clinical deterioration.Conclusions. This initial evaluation demonstrated that the charts were perceived as appropriate for documenting observations and as a prompt to detect clinical deterioration. Further evaluation after some minor modifications to the chart is recommended.What does this paper contribute to the wider global clinical community?• Implementing practice initiatives to improve recognition and response to clinical deterioration (the afferent limb of the rapid response system) remains a global healthcare challenge This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. Relevance to clinical practice. Explicit training on the principles and rationale of human factors chart design, use of embedded change management strategies and addressing practical issues will improve authentic engagement, staff acceptance and adoption by all clinical users when implementing a similar observation and response chart into practice.

Nurses' role in recognising and responding to clinical deterioration in surgical patients

“…In contrast, to previous studies that found that nurses activated rapid response systems based on clinical judgement and intuition rather than predefined MET call criteria (Bagshaw et al., ; Beaumont et al., ; Jones, Baldwin et al., ; Odell et al., ), the nurses working on the post‐operative surgical wards reported that most pre‐MET or MET calls were based on abnormal vital signs with occasional activation using the “clinician concern” criterion (Considine et al., ; Elliott et al., ). This demonstrates that the surgical nurses were basing their identification of clinical deterioration on objective criteria rather than subjective intuition alone (Douw et al., ; Santiano et al., ).…”

Emergency Department presentation of frail older people and interventions for management: Geriatric Emergency Department Intervention

“…The Adult Deterioration Detection System (ADDS) score [36] is calculated using the ADDS charting tool and used as an early warning of deterioration. Health professionals are reported to agree strongly on the ease of use of the ADDS chart and subsequent risk scoring system [37]. Additional data collected by the primary nurse in the ED such as falls risk and pain assessment are also considered.…”

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

“…This study highlighted that a population of healthcare professionals (nurses and doctors) made a similar number of errors in their documentation of vital signs on the EWS chart as a group of non‐healthcare professionals (Preece et al, ). Chart designs were trialed in the study by Elliot et al () where modifications could be made based on the presentation and trend of the patient's vital signs, however, the nurses identified that while it is a theoretically a good suggestion, they pre‐empted that the chart would not be completed by doctors. The inability to see a patient's trend of vital signs was highlighted by Elliot et al () as a cause of concern when using the EWS charts.…”

“…Chart designs were trialed in the study by Elliot et al () where modifications could be made based on the presentation and trend of the patient's vital signs, however, the nurses identified that while it is a theoretically a good suggestion, they pre‐empted that the chart would not be completed by doctors. The inability to see a patient's trend of vital signs was highlighted by Elliot et al () as a cause of concern when using the EWS charts. Charts frequently only require a dot aligned on a scale or a range of values.…”