A call for better doctor–nurse collaboration: A qualitative study of the experiences of junior doctors and nurses in escalating care for deteriorating ward patients

Chua, Wei Ling; Legido‐Quigley, Helena; Jones, Daryl; Hassan, Norasyikin; Tee, Augustine; Liaw, Sok Ying

doi:10.1016/j.aucc.2019.01.006

Cited by 63 publications

(104 citation statements)

References 46 publications

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“…22,36 Clearly defined documentation-charts and protocols made staff more confident about seeking help. 20,32,39 Ward staff reported using a combination of the call-criteria and their clinical judgement 14,33,40 : " It should be an in-hand system, but it shouldn't be the system. 14 It was a facilitator when nurses could call the RRT based on clinical impression and concern 29 or if they felt the primary physician/on-call physician was not "doing their job", was inexperienced, 40 or unavailable.…”

Section: The Missing Link Between Measuring and Interpreting Vital Signsmentioning

confidence: 99%

“…14 It was a facilitator when nurses could call the RRT based on clinical impression and concern 29 or if they felt the primary physician/on-call physician was not "doing their job", was inexperienced, 40 or unavailable. 29,33,37,40 The availability of real-time data via technological solutions facilitated the RRS by allowing doctors to access patient's vitals from other sites. However, this technology could be a barrier if access was cumbersome in emergency situations; e.g.…”

Section: The Missing Link Between Measuring and Interpreting Vital Signsmentioning

confidence: 99%

“…19,32 HCP reported that in daytime, they preferred to call the primary team rather than the RRT because of their familiarity with the patient's condition. 40 The complex inter-professional "knotworking" process HCP believing that the RRT brought expertise and could expedite transfer of patients to higher-level care and improved patient outcomes30 facilitated the RRS. However, the nature of the detection/decision-making process differed between nurses (hierarchical and protocol-based) and physicians (autonomous).…”

Section: The Missing Link Between Measuring and Interpreting Vital Signsmentioning

confidence: 99%

“…29,30 The severity of clinical change The perceived severity of a patients clinical condition influenced the likelihood of a RRT activation, with high EWS 35 or abrupt/serious changes being an acceptable trigger for RRT calls. 31,40 Physicians described the RRT as " . .…”

Section: The Missing Link Between Measuring and Interpreting Vital Signsmentioning

confidence: 99%

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Succeeding with rapid response systems – a never-ending process: A systematic review of how health-care professionals perceive facilitators and barriers within the limbs of the RRS

et al. 2019

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Background: Meta-analyses show that hospital rapid response systems (RRS) are associated with reduced rates of cardiorespiratory arrest and mortality. However, many RRS fail to provide appropriate outcomes. Thus an improved understanding of how to succeed with a RRS is crucial. By understanding the barriers and facilitators within the limbs of a RRS, these can be addressed.Objective: To explore the barriers and facilitators within the limbs of a RRS as described by health-care professionals working within the system. Methods:The electronic databases searched were: EMBASE, MEDLINE, CINAHL, Epistemonikos, Cochrane, PsychInfo and Web of Science. Search terms were related to RRS and their facilitators and barriers. Studies were appraised guided by the CASP tool. Twenty-one qualitative studies were identified and subjected to content analysis.Results: Clear leadership, interprofessional trust and collaboration seems to be crucial for succeeding with a RRS. Clear protocols, feedback, continuous evaluation and interprofessional training were highlighted as facilitators. Reprimanding down the hierarchy, underestimating the importance of call-criteria, alarm fatigue and a lack of integration with other hospital systems were identified as barriers. Conclusion:To succeed with a RRS, the keys seem to lie in the administrative and quality improvement limbs. Clear leadership and continuous quality improvement provide the foundation for the continuing collaboration to manage deteriorating patients. Succeeding with a RRS is a never-ending process.

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Section: The Missing Link Between Measuring and Interpreting Vital Signsmentioning

confidence: 99%

Section: The Missing Link Between Measuring and Interpreting Vital Signsmentioning

confidence: 99%

Section: The Missing Link Between Measuring and Interpreting Vital Signsmentioning

confidence: 99%

Section: The Missing Link Between Measuring and Interpreting Vital Signsmentioning

confidence: 99%

See 2 more Smart Citations

Succeeding with rapid response systems – a never-ending process: A systematic review of how health-care professionals perceive facilitators and barriers within the limbs of the RRS

et al. 2019

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“…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, ). A qualitative study, based in New Zealand with both nurses and doctors identified that mutual respect and trust is necessary for an effective working relationship (Pullon, ).…”

Section: Discussionmentioning

confidence: 99%

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

Treacy

Stayt

2019

Journal of Advanced Nursing

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Aims To identify factors that influence recognition and response to adult patient deterioration in acute hospitals. Design A mixed‐studies systematic review. Data Sources CINAHL, Medline, and Web of Science were searched for relevant literature published between 2007 – 2018. Review Methods Studies were critically appraised, data extracted and thematically analysed. Results Thirteen papers met the inclusion criteria. Three main themes were identified: (a) Knowledge and understanding of clinical deterioration; (b) Organizational factors; managing deterioration and staffing levels; and (c) Communication; inter‐professional relationships and professional‐patient communication. Conclusion Despite national guidelines, the review findings suggest that the recognition and response to adult patient deterioration in acute hospital settings is sub‐optimal. A multitude of factors influencing the recognition and response to adult patient deterioration emerged from the findings. Impact Patients are receiving sub‐optimal care due to failure in recognizing and responding to patient deterioration in an appropriate and timely manner. Nurses lack knowledge and understanding of deterioration. Organizational factors contribute to inadequate care and communication among professionals was highlighted as challenging. The factors that influence the recognizing and responding to patient deterioration in acute hospitals are multi‐faceted, however this review highlights immediate recommendations for professionals in the acute care setting.

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The use of altered rapid response calling criteria in a tertiary referral facility

Crouch

Trahair

Aitken

2021

Australian Critical Care

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Purpose:The purpose of this study was to examine the current utilisation of altered rapid response call criteria (ARRCC) at a tertiary hospital. Methods :A retrospective review of all acute care admissions across 17 months was undertaken using the hospital administration system and electronic medical record to identify patients with ARRCC. In patients with altered criteria, the type of alteration, frequency of rapid response call, cardiac arrest, intensive care admission and death in hospital were identified.Comparisons were made using standard statistical methods.Results : Total hospital admissions numbered 45,912, with ARRCC used in 768 (1.7%) of these. Patients with an ARRCC during hospital admission were older (68.5 [55.5, 79.0] vs 59.0 [43.0, 72.0] years, p<0.001) and had a significantly longer length of hospital stay (6.9 [3.0,16.3] vs 2 [1,5] days, p<0.001).Compared with the total group of patient admissions, patients with ARRCC more frequently triggered a rapid response team (9.0% vs 14.2%, X 2 (1, n=46680) = 23.87, p<0.001), more frequently suffered a cardiac arrest (0.2 vs 0.9%, X 2 (1, n=46678) = 20.34, p<0.001), more frequently died in hospital (p<0.001), and less frequently were discharged home (X 2 (1, n=46680) = 43.91, p<0.001). Conclusion :Patients with an ARRCC stayed longer in hospital and were at increased risk of cardiac arrest and death during hospitalisation. Further exploration of the role of ARRCC in facilitating individualised care to meet the needs and treatment goals of each patient in the acute hospital setting is required.

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A call for better doctor–nurse collaboration: A qualitative study of the experiences of junior doctors and nurses in escalating care for deteriorating ward patients

Cited by 63 publications

References 46 publications

Succeeding with rapid response systems – a never-ending process: A systematic review of how health-care professionals perceive facilitators and barriers within the limbs of the RRS

Succeeding with rapid response systems – a never-ending process: A systematic review of how health-care professionals perceive facilitators and barriers within the limbs of the RRS

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

The use of altered rapid response calling criteria in a tertiary referral facility

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