A mixed-methods investigation of health professionals’ perceptions of a physiological track and trigger system

Abstract

BackgroundPhysiological track and trigger systems (PTTSs) regulate the monitoring of patients’ vital signs and facilitate the detection and treatment of deteriorating patients. These systems are widely used, although compliance with protocol is often poor.ObjectiveThis study aimed to examine the perceptions of a national PTTS among nurses and doctors and to identify the variables that impact on intention to comply with protocol.MethodsA mixed-methods research design was employed. During the initial qualitative phase, 30 hospital-based nurses and doctors participated in a series of semistructured interviews. During the subsequent quantitative phase, 215 nurses and doctors (24.1% response rate) responded to a questionnaire designed to assess attitudes towards the PTTS and factors that influence adherence to protocol.ResultsInterview data revealed largely positive attitudes towards the PTTS but highlighted a number of barriers to its implementation and indicated that it is sometimes a source of tension between doctors and nurses. Quantitative data confirmed the validity of these findings, although nurses appeared to have more positive attitudes towards, and to perceive fewer barriers to, the usage of PTTS than were reported by the participating doctors.ConclusionsThese findings reveal that non-compliance with PTTS protocol is unlikely to be attributable to negative perceptions of PTTSs. Instead, there are a number of barriers to the implementation of the system. These findings suggest that interprofessional training in PTTSs is essential while increased support for PTTS implementation among senior doctors would also yield improved adherence to protocol.

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

“…Donohue and Endacott () identified that nurses expressed frustration at the delays in response from doctors, however they perceived RRT as being more responsive to their requests. A mixed method study by Lydon, Byrne, Offiah, Gleeson, and O’Connor () highlighted nurses are using the EWS to escalate their concerns, however, felt that once the EWS had been reported by the nurses’ they did not take any further responsibility. Furthermore, use of EWS was criticized by Lydon et al (), as they posited that the use of EWS limits nurses’ clinical judgement and subsequent role in recognizing deterioration.…”

“…A mixed method study by Lydon, Byrne, Offiah, Gleeson, and O’Connor () highlighted nurses are using the EWS to escalate their concerns, however, felt that once the EWS had been reported by the nurses’ they did not take any further responsibility. Furthermore, use of EWS was criticized by Lydon et al (), as they posited that the use of EWS limits nurses’ clinical judgement and subsequent role in recognizing deterioration. The qualitative data in this study indicated that Doctors mostly viewed EWS as positive, as EWS provides a clear process for referral to a more senior clinician.…”

“…Lydon et al () further reported that doctors expressed frustration that nurses often only reported the EWS but were unable to provide additional, pertinent, clinical information. A cross‐sectional survey of nurses (86.1%) and midwives (13.1%) by Osborne et al () identified that patient assessment mostly comprised of only vital sign assessment.…”

“…A cross‐sectional survey of nurses (86.1%) and midwives (13.1%) by Osborne et al () identified that patient assessment mostly comprised of only vital sign assessment. In addition, the nurse participant in Lydon et al's () study indicated that they felt that their key responsibility was to report the EWS, with one participant stating, “once you call, you are protected” (Lydon et al, , p. 691). Furthermore, Endacott et al (), highlighted that often doctors did not trust nurse's reports; doctors revealed that nurses often failed to provide objective information regarding the patient's condition, which resulted as a barrier to escalation.…”

“…The benefits of assessment tools such as EWS were reported however some healthcare professionals suggested that such tools removed the need for clinical judgment (Lydon et al, ). The Royal College of Physicians () however emphasize that NEWS2 is not a substitute for competent clinical competence (RCP, 2017).…”