Assessment and communication excellence for safe patient outcomes (ACCELERATE): A stepped-wedge cluster randomised trial protocol

Rihari-Thomas, John; Whittam, Susan; Goncharov, Liza; Slade, Diana; McElduff, Benjamin; Pritchard, Tanya; McMahon, Jake; Coventry, Alysia; Coughlan, Kelly; Steadward, Yvonne; Taylor, Joanne; Thornton, Alex; Riddell, Kathryn; Tuqiri, Karen; Olesen, Kim; Dahm, Maria R.; Chien, Laura; Kelly, Patrick J.; McInnes, Elizabeth; Middleton, Sandy

doi:10.1016/j.colegn.2022.06.006

Cited by 4 publications

(4 citation statements)

References 21 publications

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“…Secondly, as noted by others, it is incumbent on the profession to promote ownership of holistic patient assessments as a core nursing competency (Douglas et al., 2016). Structured frameworks such as the ABCDE primary survey are predicted to facilitate the proactive identification of early and subtle signs of deterioration (Rihari‐Thomas et al., 2022). Reinforcing the active application of the primary survey approach in training situations that reflect subtle and acute deterioration is recommended.…”

Section: Discussionmentioning

confidence: 99%

A cognitive task analysis of final year nursing students' situation awareness in simulated deteriorating patient events: A mixed methods study

Walshe,

Drennan,

Hegarty

et al. 2024

Nursing Open

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AimThe aim of this study was to: (1) use cognitive task analysis to describe final year nursing students situation awareness in recognising, responding and escalating care of deteriorating patients in ward settings; and (2) make recommendations for training and practice.DesignA mixed methods cognitive task analysis with a convergent triangulation design.MethodData collection involved observations of 33 final year nursing students in simulated deteriorating patient scenarios and retrospective cognitive interviews. A process tracing technique was applied to identify the cues to deterioration participants perceived; how cue perception altered as situational demands increased; the extent that participants made connections between perceived cues and reached a situational understanding; and the factors that influenced and constrained participants situation awareness. Qualitative and quantitative findings are woven together and presented using descriptive statistics, illustrative quotations and timeline extractions.ResultsThe median cue perception was 65.4% and 57.6% in the medical and surgical scenarios, respectively. Perception was negatively influenced by incomplete vital sign monitoring as situations escalated; limited physical assessments; passive scanning behaviours; poor task automaticity; and excessive cognitive demands. Incomplete perception, poor cue integration and underdeveloped mental models influenced situational understanding. Escalation calls did not always accurately reflect situations and a reporting mindset was evident. Clinical exposure to deteriorating patients was described as variable and opportunistic.Reporting MethodThe study is reported in accordance with the Good Reporting of a Mixed Methods Study (GRAMMS) checklist.Patient or Public ContributionPatients and public were not involved in this research.

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Section: Discussionmentioning

confidence: 99%

A cognitive task analysis of final year nursing students' situation awareness in simulated deteriorating patient events: A mixed methods study

Walshe,

Drennan,

Hegarty

et al. 2024

Nursing Open

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“…In terms of patient outcomes, findings from this review indicate using assessment frameworks or tools improved the quality and comprehensiveness of the nursing process and documentation (Derdiarian, 1990), increased completion of daily assessments and interventions (Harris et al, 1998) and treatment delays (Curtis et al, 2009). More research is underway in this area, which is greatly needed, and we look forward to the outcome of the assessment and communication excellence for safe patient outcomes (ACCELERATE) trial, which proposes to implement and evaluate the feasibility and effectiveness of an organizational ward-level intervention on systematic assessment and communication in clinical handover (Rihari-Thomas et al, 2022).…”

Section: Discussionmentioning

confidence: 99%

The impact of whole of patient nursing assessment frameworks on hospital inpatients: A scoping literature review

Wiseman,

Kourouche,

Jones

et al. 2023

Journal of Advanced Nursing

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IntroductionA comprehensive patient assessment is essential for safe patient care. Patient assessment frameworks for nurses are generally restricted to patients who already have altered vital signs and are at risk of deterioration, or to specific risks or body systems such as falls, pressure injury and the Glasgow Coma Score. Comprehensive and structured evidence‐based nursing assessment frameworks that consider the whole patient and extend beyond vital signs, specific risks and single systems are not routinely used in inpatient settings but are important to establish early risks for patient deterioration.AimThe aim of this review was to identify nursing assessment tools or frameworks used to holistically assess hospitalized patients and to identify the impact of these tools on patient and health service outcomes.MethodsA scoping literature review was conducted. Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index of Nursing and Allied Health Literature (CINAHL), ProQuest Dissertations and Thesis, Embase and Scopus were databases used in the search. The initial search was conducted in August 2021 and repeated in November 2022. No date parameters were set. The Participants, Concept, Context (PCC) framework was used to guide the development of the research question and consolidate inclusion and exclusion criteria. The PRISMA‐ScR Checklist Item was followed to ensure a methodologically sound checklist was used.ResultsTen primary research studies evaluating six nursing assessment frameworks were included. Of the five nursing assessment frameworks, none were explicitly designed for general ward nursing, but rather the emergency department or specific patient cohorts, such as oncology. Four studies reported on reliability and/or validity; two reported on patient outcomes and four on staff satisfaction.ConclusionEvidence‐based nursing patient assessment frameworks for use in general inpatient wards are lacking. Existing assessment tools are largely designed for specific patient cohorts, specific body systems or the already deteriorating patient.Implications for the Profession and Patient CareA framework to enable a structured approach to patient assessment in this environment is needed for patient safety, consistency in assessment, nursing staff enablement and confidence to escalate care. Routine systematic nursing assessment could also aid timely patient escalation.ImpactWhat problem did the study address? This study addresses the lack of evidence‐based nursing assessment frameworks for use in hospitalized patients. The impact of this is that it highlights the need for an evidence‐based, whole of patient assessment framework for use by nurses for patients admitted to a ward environment.What were the main findings? This review identified limited comprehensive, patient assessment frameworks for use in general ward inpatient areas. Those identified were not validated for this patient cohort and are aimed at patients already deteriorating.Where and on whom will the research have an impact? This review has the potential to impact future research and patient care. It highlights that most research is focussed on processes to detect and escalate care for the already deteriorating patient. There is a need for an evidence‐based routine nursing assessment framework for patients admitted to a ward environment to promote positive patient outcomes and prevent deterioration.Patient and Public ContributionThis review contributes to existing knowledge of nursing patient assessment frameworks, yet it also highlights several gaps. Currently, there are no known, validated, holistic, structured nursing patient assessment frameworks for use in general ward inpatient settings. However, areas that do use such assessment frameworks (e.g. the emergency department) have shown positive patient outcomes and staff usability. Hospitalized ward patients would benefit from routine, structured nursing assessments targeting positive patient outcomes prior to the onset of deterioration.

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“…Strategies to confirm reliability included using a structured nursing handover observation tool when recording observations, checking verbatim transcripts for accuracy and, for the linguistic analysis, discussing informational and interactional categories with the research team. Pre‐post studies have validated the use of the ISBAR and CARE protocols to improve nursing handover (Pun, 2023; Slade et al., 2018), and the training has been adapted in nursing trials to improve patient safety (Liu et al., 2023; Rihari‐Thomas et al., 2022). The study is reported in line with the Standards for Reporting Qualitative Research (O'Brien et al., 2014) and the Consolidated Criteria for Reporting Qualitative Research (Tong et al., 2007) (Appendix S7).…”

Section: Methodsmentioning

confidence: 99%

“…Rihari-Thomas et al, 2022). The study is reported in line with the Standards for Reporting Qualitative Research(O'Brien et al, 2014) and the Consolidated Criteria for Reporting Qualitative Research(Tong et al, 2007) (Appendix S7).…”

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confidence: 99%

Implementing a ward‐level intervention to improve nursing handover communication with a focus on bedside handover—A qualitative study

Chien,

Slade,

Goncharov

et al. 2024

Journal of Clinical Nursing

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AimTo improve the effectiveness of nursing clinical handover through a qualitative, tailored communication intervention.DesignA multisite before and after intervention using qualitative ethnography combined with discourse analysis of nursing handover interactions.MethodsWe implemented a tailored ward‐based intervention to redesign nursing handover practice with co‐constructed recommendations for organisational and cultural change on seven wards across three affiliated metropolitan hospitals between February 2020 and November 2022. The intervention was informed by pre‐implementation interviews and focus groups with nursing, medical and allied health staff and patients (n = 151) and observed and/or audio‐recorded handover events (n = 233). Post‐intervention we conducted interviews and focus groups (n = 79) and observed and/or audio‐recorded handover events (n = 129) to qualitatively evaluate impact.ResultsOur translational approach resulted in substantial changes post‐intervention. Nurses conducted more shift‐to‐shift handovers at the bedside, with greater patient interaction and better structured and more comprehensive information transfer, supported by revised handover documentation. Redesigned group handovers were focused and efficient, communicating critical patient information.ConclusionContextualised training combined with changes to ward‐level systemic factors impeding communication results in improved nursing handovers. Practice change requires strong executive leadership and project governance, combined with effective ward‐level leadership, collaboration and mentoring. The speed and degree of change post‐intervention demonstrates the power of interdisciplinary collaborative research between hospital executive, ward leadership and communication specialists.Relevance to Clinical PracticeNurses are more likely to conduct efficient group handovers and informative, patient‐centred bedside handovers in line with policy when they understand the value of handover and have practical strategies to support communication. Communication training should be combined with broader ward‐level changes to handover practice tailored to the ward context. A multilevel approach results in more effective practice change.Reporting MethodWe adhered to the COREQ guidelines.Patient or Public ContributionWe interviewed patients on study wards pre and post intervention.

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Assessment and communication excellence for safe patient outcomes (ACCELERATE): A stepped-wedge cluster randomised trial protocol

Cited by 4 publications

References 21 publications

A cognitive task analysis of final year nursing students' situation awareness in simulated deteriorating patient events: A mixed methods study

A cognitive task analysis of final year nursing students' situation awareness in simulated deteriorating patient events: A mixed methods study

The impact of whole of patient nursing assessment frameworks on hospital inpatients: A scoping literature review

Implementing a ward‐level intervention to improve nursing handover communication with a focus on bedside handover—A qualitative study

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