Identifying Deteriorating Patients Through Multidisciplinary Team Training

Abstract

Multidisciplinary training has improved maternity outcomes when the training has been well attended, regular, in house, used high-fidelity simulators, and integrated teamwork training. If these principles were used in other settings, better clinical care may result. This before-after study sought to establish whether a short multidisciplinary training intervention can improve recognition of the deteriorating patient using an aggregated physiological parameter scoring system (Early Warning Score [EWS]). Nursing, medical, and allied nursing staff participated in an hour-long training session, using real-life scenarios with simple tools and structured debriefing. After training, staff were more likely to calculate EWS scores correctly (68.02% vs 55.12%; risk ratio [RR] = 1.24, 95% confidence interval [CI] = 1.07-1.44), and observations were more likely to be performed at the correct frequency (78.57% vs 68.09%; RR = 1.20, 95% CI = 1.09-1.32). Multidisciplinary training, according to core principles, can lead to more accurate identification of deteriorating patients, with implications for subsequent care and outcome.

The effect of adult Early Warning Systems education on nurses’ knowledge, confidence and clinical performance: A systematic review

“…(). Six countries were represented across the reviewed studies with the greater numbers conducted in the United States ( n = 3), (Lindsey & Jenkins, ; Ozekcin, Tuite, Willner, & Hravnak, ; Rose, Hanna, Nur, & Johnson, ), Singapore ( n = 2) (Liaw, Chan, Chen, Hooi, & Siau, ; Liaw, Wong, Ang, et al., ; Liaw, Wong, Chan, et al., ), in hospitals ( n = 7) (Cahill et al., ; Kyriacos, Jelsma, James, & Jordan, ; Ludikhuize, De Jonge, & Goossens, ; Merriel et al., ; Ozekcin et al., ; Rose et al., ; Shaddel, Khosla, & Banerjee, ) and simulation settings ( n = 3) (Liaw, Wong, Ang, et al., ; Liaw, Wong, Chan, et al., ; Lindsey & Jenkins, ). Sample size varied between 19 (Shaddel et al., ) and 147 (Cahill et al., ) participants.…”

“…Sample size varied between 19 (Shaddel et al., ) and 147 (Cahill et al., ) participants. Five studies used a pre‐ and post‐test design (Cahill et al., ; Merriel et al., ; Ozekcin et al., ; Rose et al., ; Shaddel et al., ), four studies were RCTs (Kyriacos et al., ; Liaw, Wong, Ang, et al., ; Liaw, Wong, Chan, et al., ; Lindsey & Jenkins, ) and one study was quasi‐experimental (Ludikhuize et al., ). As for the educational interventions used in the reviewed studies, they included the following: interactive programmes, namely Rescuing a Patient in Deteriorating Situations (RAPIDS) (Liaw et al., ) and e‐RAPIDS (Liaw, Wong, Ang, et al., ; Liaw, Wong, Chan, et al., ); fully automated virtual patient simulation and facilitator‐led mannequin‐based simulation (Liaw et al., ); MEWS charts and the Cape Town MEWS training programme and manual (Kyriacos et al., ); educational sessions about a new observation chart (Cahill et al., ); code blue simulation and rapid response education (Lindsey & Jenkins, ); a fictional deteriorating patient (Ludikhuize et al., ); an EWS training session (Merriel et al., ); an e‐learning module and simulation (Ozekcin et al., ); and one‐on‐one and small group education about e‐MEWS (Rose et al., ) and MEWS (Shaddel et al., ).…”

“…The effectiveness of the interventions was assessed using several researcher‐designed instruments, namely a knowledge questionnaire and performance tool (Liaw, Wong, Ang, et al., ; Liaw, Wong, Chan, et al., ); written tests (Kyriacos et al., ); multiple choice questionnaires (Lindsey & Jenkins, ; Ozekcin et al., ); clinical observations (Ludikhuize et al., ); and chart reviews and audits (Merriel et al., ; Rose et al., ).…”

“…Generally, nurses in the reviewed studies correctly calculated early warning scores (i.e. recorded a full set of vital signs and computed the corresponding EWS) following exposure to the educational programmes (Liaw et al., ; Liaw, Wong, Ang, et al., ; Liaw, Wong, Chan, et al., ; Ludikhuize et al., ; Merriel et al., ; Ozekcin et al., ; Shaddel et al., ). Merriel et al.…”

Modified Early Warning System (Mews), Indicator Of Changes In Patient's Condition In The General Wards: A Sistematic Review

“…Research by [10] explained that after received training, the staff were more likely to calculate a score EWS correctly (68.02% versus 55.12%; risk ratio [RR] = 1.24, 95% confidence interval [CI] = 1.07-1.44), and observations may performed at the appropriate frequency (78.57% versus 68.09%; RR = 1.20, 95% CI = 1.09 to 1.32). Research by [11] explained that the period of 30 months, 234 patients suffering cardiac arrest during the emergency, and 99 patients with Periarrest MEWS included in the final analysis.…”