Deterioration to decision: a comprehensive literature review of rapid response applications for deteriorating patients in acute care settings

Baig, Mirza Mansoor; Afifi, Shereen; GholamHosseini, Hamid; Ullah, Ehsan

doi:10.1007/s12553-019-00403-7

Cited by 11 publications

(7 citation statements)

References 45 publications

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“…No other details provided. Lydon (2016), [ 30 ] Ireland 1 teaching hospital Mixed Methods, semi-structured interviews Analysis: Deductive content analysis 30 participants: Interns [1st year of postgraduate training] [ 18 ], Senior NCHDs [ 2 ], Nurses [ 10 ] 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. A PTTS using the NEWS and ISBAR communication tool Mackintosh (2012), [ 20 ] UK 2 tertiary teaching hospitals **Same sample as Mackintosh (2014) Ethnography; Observation of interactions among multi-professional healthcare staff and patient management processes; semi-structured interviews.…”

Section: Resultsmentioning

confidence: 99%

“…Previous research has raised questions about the overall effectiveness of EWSs and RRTs, [ 6 , 7 ], however minimal research has focused on how EWSs and RRTs are viewed by the HCPss who use them in practice. Studies have shown that even though a number of serious adverse events have occurred, in very few instances (8% in one study) [ 8 ] was the escalation protocol strictly adhered to [ 8 – 10 ]. Why this is the case is vital information for national level guidance and planning, including for hospital managers to more fully understand the implications of EWS and RRT implementation for those who use them in practice every day.…”

Section: Introductionmentioning

confidence: 99%

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Why do healthcare professionals fail to escalate as per the early warning system (EWS) protocol? A qualitative evidence synthesis of the barriers and facilitators of escalation

et al. 2021

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Background Early warning systems (EWSs) are used to assist clinical judgment in the detection of acute deterioration to avoid or reduce adverse events including unanticipated cardiopulmonary arrest, admission to the intensive care unit and death. Sometimes healthcare professionals (HCPs) do not trigger the alarm and escalate for help according to the EWS protocol and it is unclear why this is the case. The aim of this qualitative evidence synthesis was to answer the question ‘why do HCPs fail to escalate care according to EWS protocols?’ The findings will inform the update of the National Clinical Effectiveness Committee (NCEC) National Clinical Guideline No. 1 Irish National Early Warning System (INEWS). Methods A systematic search of the published and grey literature was conducted (until February 2018). Data extraction and quality appraisal were conducted by two reviewers independently using standardised data extraction forms and quality appraisal tools. A thematic synthesis was conducted by two reviewers of the qualitative studies included and categorised into the barriers and facilitators of escalation. GRADE CERQual was used to assess the certainty of the evidence. Results Eighteen studies incorporating a variety of HCPs across seven countries were included. The barriers and facilitators to the escalation of care according to EWS protocols were developed into five overarching themes: Governance, Rapid Response Team (RRT) Response, Professional Boundaries, Clinical Experience, and EWS parameters. Barriers to escalation included: Lack of Standardisation, Resources, Lack of accountability, RRT behaviours, Fear, Hierarchy, Increased Conflict, Over confidence, Lack of confidence, and Patient variability. Facilitators included: Accountability, Standardisation, Resources, RRT behaviours, Expertise, Additional support, License to escalate, Bridge across boundaries, Clinical confidence, empowerment, Clinical judgment, and a tool for detecting deterioration. These are all individual yet inter-related barriers and facilitators to escalation. Conclusions The findings of this qualitative evidence synthesis provide insight into the real world experience of HCPs when using EWSs. This in turn has the potential to inform policy-makers and HCPs as well as hospital management about emergency response system-related issues in practice and the changes needed to address barriers and facilitators and improve patient safety and quality of care.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Why do healthcare professionals fail to escalate as per the early warning system (EWS) protocol? A qualitative evidence synthesis of the barriers and facilitators of escalation

et al. 2021

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“…A specially trained team continuously monitors the vital signs of patients and provides immediate critical care when the patients are at risk [ 2 ]. In other words, they are responsible for recognizing early signs of deterioration in patients and responding appropriately to prevent subsequent events and reduce patient mortality [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

ROMI: A Real-Time Optical Digit Recognition Embedded System for Monitoring Patients in Intensive Care Units

Jeon

Son

2023

Sensors

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With advances in the Internet of Things, patients in intensive care units are constantly monitored to expedite emergencies. Due to the COVID-19 pandemic, non-face-to-face monitoring has been required for the safety of patients and medical staff. A control center monitors the vital signs of patients in ICUs. However, some medical devices, such as ventilators and infusion pumps, operate in a standalone fashion without communication capabilities, requiring medical staff to check them manually. One promising solution is to use a robotic system with a camera. We propose a real-time optical digit recognition embedded system called ROMI. ROMI is a mobile robot that monitors patients by recognizing digits displayed on LCD screens of medical devices in real time. ROMI consists of three main functions for recognizing digits: digit localization, digit classification, and digit annotation. We developed ROMI by using Matlab Simulink, and the maximum digit recognition performance was 0.989 mAP on alexnet. The developed system was deployed on NVIDIA GPU embedded platforms: Jetson Nano, Jetson Xavier NX, and Jetson AGX Xavier. We also created a benchmark by evaluating the runtime performance by considering ten pre-trained CNN models and three NVIDIA GPU platforms. We expect that ROMI will support medical staff with non-face-to-face monitoring in ICUs, enabling more effective and prompt patient care.

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“…Previous research has raised questions about the overall effectiveness of EWSs and RRTs, (6,7), however minimal research has focused on how EWS and RRTs are viewed by the health care professionals who use them in practice. Studies have shown that even though a number of serious adverse events have occurred, in very few instances (8% in one study) (8) was the escalation protocol strictly adhered to (8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Why do healthcare professionals fail to escalate as per the Early Warning System (EWS) protocol? A qualitative evidence synthesis of the barriers and facilitators of escalation

Neill

Clyne

Bell

et al. 2021

Preprint

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Background: Early warning systems (EWSs) are used to assist clinical judgment in the detection of acute deterioration to avoid or reduce adverse events including unanticipated cardiopulmonary arrest, admission to the intensive care unit and death. Sometimes healthcare professionals (HCPs) do not trigger the alarm and escalate for help according to the EWS protocol and it is unclear why this is the case. The aim of this qualitative evidence synthesis was to answer the question ‘why do HCPs fail to escalate care according to EWS protocols?’ The findings will inform the update of the National Clinical Effectiveness Committee (NCEC) National Clinical Guideline No. 1 Irish National Early Warning System (INEWS). Methods: A systematic search of the published and grey literature was conducted (until February 2018). Data extraction and quality appraisal were conducted by two reviewers independently using standardised data extraction forms and quality appraisal tools. A thematic synthesis was conducted by two reviewers of the qualitative studies included and categorized into the barriers and facilitators of escalation. GRADE CERQual was used to assess the certainty of the evidence.Results: Eighteen studies incorporating a variety of HCPs across seven countries were included. The barriers and facilitators to the escalation of care according to EWS protocols were developed into five overarching themes: Governance, Rapid Response Team (RRT) Response, Professional Boundaries, Clinical Experience, and EWS parameters. Barriers to escalation included: Lack of Standardisation, Resources, Lack of accountability, RRT behaviours, Fear, Hierarchy, Increased Conflict, Over confidence, Lack of confidence, and Patient variability. Facilitators included: Accountability, Standardisation, Resources, RRT behaviours, Expertise, Additional support, License to escalate, Bridge across boundaries, Clinical confidence, Empowerement, Clinical judgment, and a tool for detecting deterioration. These are all individual yet inter-related barriers and facilitators to escalation. Conclusions: The findings of this qualitative evidence synthesis provide insight into the real world experience of HCPs when using EWSs. This in turn has the potential to inform policy-makers and HCPs as well as hospital management about emergency response system-related issues in practice and the changes needed to address barriers and facilitators and improve patient safety and quality of care.

show abstract

Deterioration to decision: a comprehensive literature review of rapid response applications for deteriorating patients in acute care settings

Cited by 11 publications

References 45 publications

Why do healthcare professionals fail to escalate as per the early warning system (EWS) protocol? A qualitative evidence synthesis of the barriers and facilitators of escalation

Why do healthcare professionals fail to escalate as per the early warning system (EWS) protocol? A qualitative evidence synthesis of the barriers and facilitators of escalation

ROMI: A Real-Time Optical Digit Recognition Embedded System for Monitoring Patients in Intensive Care Units

Why do healthcare professionals fail to escalate as per the Early Warning System (EWS) protocol? A qualitative evidence synthesis of the barriers and facilitators of escalation

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