Critical care clinician perceptions of factors leading to Medical Emergency Team review

Currey, Judith; Allen, Joshua L.; Jones, Daryl

doi:10.1016/j.aucc.2017.03.003

Cited by 28 publications

(33 citation statements)

References 29 publications

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“…25 Conversely, poor governance associated with a lack of protocols or equipment, poor logistics and lack of commitment by senior staff and management were viewed as barriers. 27 Unclear protocols with lack of integration in handover processes Confusion around when to call the RRT and their optimal response 26À33 was a frequently reported barrier. By contrast, clear call-criteria, including the expectation that when in doubt, a call should be made, was described as a facilitator.…”

Section: Administrative and Quality Improvement Limbsmentioning

confidence: 99%

“…34,35 Cooperation and patient flow were facilitated by incorporating RRT events into the handover processes and daily use of early warning scores (EWS) in unit rounds. 22,28 Inconsistent education Low priority of education regarding the RRS and management of deteriorating patients 14,25,30 was a barrier while training was a facilitator, 25,27,36 with an emphasis on joint training sessions between ward staff and the RRT 35 and the use of simulation-based training. 25 Training in the use of EWS as early as in university was described as a facilitator.…”

Section: Administrative and Quality Improvement Limbsmentioning

confidence: 99%

“…35 Not wanting to disturb a busy ICU-nurse or physician, 28,29 or knowing the ICU was (continued on next page) 30 HCP describe lacking a system to determine how and when additional resources could be provided. 35 Other barriers were not having hospital-wide systems for end-of-life-care decisions and planning, 27,38 pain management and palliative care services. 38 Missing electronic tracking of vital signs and non-integration of monitoring with other infrastructure was a barrier.…”

Section: Administrative and Quality Improvement Limbsmentioning

confidence: 99%

“…38 Missing electronic tracking of vital signs and non-integration of monitoring with other infrastructure was a barrier. 27 As were poorly designed documentation-charts, the simultaneous use of multiple charts 27,32 and different scoring-systems within one hospital. 39 Unreliable, outdated, inefficient and poorly maintained equipment hindered the RRS.…”

Section: Administrative and Quality Improvement Limbsmentioning

confidence: 99%

“…39 Unreliable, outdated, inefficient and poorly maintained equipment hindered the RRS. 21,27 The value of involvement and continuous follow-up The involvement of HCP in continuous quality improvement was described as a facilitator. 25 The availability of training, followed up by local audits and positive written responses were considered important components to succeed with the RRS, 29,34 as was a process for immediately addressing problems, such as the intimidation of nurses.…”

Section: Administrative and Quality Improvement Limbsmentioning

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: Administrative and Quality Improvement Limbsmentioning

confidence: 99%

Section: Administrative and Quality Improvement Limbsmentioning

confidence: 99%

Section: Administrative and Quality Improvement Limbsmentioning

confidence: 99%

Section: Administrative and Quality Improvement Limbsmentioning

confidence: 99%

Section: Administrative and Quality Improvement Limbsmentioning

confidence: 99%

See 3 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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Clinician and manager perceptions of factors leading to ward patient clinical deterioration

Allen

Jones

Currey

2018

Australian Critical Care

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The development and psychometric evaluation of the Clinicians' Attitudes towards Responding and Escalating care of Deteriorating patients scale

Chua

Tee

Hassan

et al. 2021

Australian Critical Care

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Background: Validated measures of ward nurses' safety cultures in relation to escalations of care in deteriorating patients are lacking.Objectives: This study aimed to develop and evaluate the psychometric properties of the Clinicians' Attitudes towards Responding and Escalating care of Deteriorating patients (CARED) scale for use among ward nurses. Methods: The study was conducted in two phases: scale development and psychometric evaluation. The scale items were developed based on a systematic literature review, informant interviews, and expert reviews (n ¼ 15). The reliability and validity of the scale were examined by administering the scale to 617 registered nurses with retest evaluations (n ¼ 60). The factor structure of the CARED scale was examined in a split-half analysis with exploratory and confirmatory factor analyses. The internal consistency, test eretest reliability, convergent validity, and known-group validity of the scale were also analysed. Results: A high overall content validity index of 0.95 was obtained from the validations of 15 international experts from seven countries. A three-factor solution was identified from the final 22 items: 'beliefs about rapid response system', 'fears about escalating care', and 'perceived confidence in responding to deteriorating patients'. The internal consistency reliability of the scale was supported with a good Cronbach's alpha value of 0.86 and a Spearman-Brown split-half coefficient of 0.87. An excellent testeretest reliability was demonstrated, with an intraclass correlation coefficient of 0.92. The convergent validity of the scale was supported with an existing validated scale. The CARED scale also demonstrated abilities to discriminate differences among the sample characteristics. Conclusions: The final 22-item CARED scale was tested to be a reliable and valid scale in the Singaporean setting. The scale may be used in other settings to review hospitals' rapid response systems and to identify strategies to support ward nurses in the process of escalating care in deteriorating ward patients.

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Critical care clinician perceptions of factors leading to Medical Emergency Team review

Cited by 28 publications

References 29 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

Clinician and manager perceptions of factors leading to ward patient clinical deterioration

The development and psychometric evaluation of the Clinicians' Attitudes towards Responding and Escalating care of Deteriorating patients scale

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