Observation chart design features affect the detection of patient deterioration: a systematic experimental evaluation

Christofidis, Melany J.; Hill, Andrew; Horswill, Mark S.; Watson, Marcus

doi:10.1111/jan.12824

Cited by 16 publications

(16 citation statements)

References 39 publications

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“…Evaluating users' views for new charts in practice is important for the developing knowledge base on elements of the afferent limb of a RRS. While objective data are necessary to develop effective evidence-based observation charts (Preece et al 2012a, Christofidis et al 2015, understanding and preferences of clinical staff (Preece et al 2013) and work culture (Williams et al 2011, Shearer et al 2012, Mackintosh et al 2014, Brier et al 2015, Douglas et al 2016 are also likely to influence successful adoption in practice (Hills 2011, Douglas et al 2016, as reflected in our findings.…”

Section: Discussionmentioning

confidence: 67%

“…From a human factors perspective, the charting area was specifically designed to improve identification of deterioration (Christofidis et al . ) by ‘tracking’ changes or patterns of individual vital signs over time (Christofidis et al . ) rather than listing a series of numbers (Christofidis et al .…”

Section: Discussionmentioning

confidence: 99%

“…) rather than listing a series of numbers (Christofidis et al . , ). A discord between actual measurements obtained, often as digital values from automated observation devices (Bellomo et al .…”

Section: Discussionmentioning

confidence: 99%

“…From a practice and patient safety perspective, participants raised concerns about the use of ranges for recording vital signs. From a human factors perspective, the charting area was specifically designed to improve identification of deterioration (Christofidis et al 2015) by 'tracking' changes or patterns of individual vital signs over time (Christofidis et al 2014) rather than listing a series of numbers (Christofidis et al 2013(Christofidis et al , 2015. A discord between actual measurements obtained, often as digital values from automated observation devices (Bellomo et al 2012), and recording vital signs in ranges was, however, apparent with our study participants in actual practice; one that may not be fully resolved until complete adoption of a digitised and networked practice environment is realised (Bates & Zimlichman 2015).…”

Section: Discussionmentioning

confidence: 99%

“…These charts incorporated an early warning score (EWS), with one version (the ADDS+) including scoring of systolic blood pressure to calculate part of a patient's EWS. The charts were subsequently tested in simulated environments (Christofidis et al 2013(Christofidis et al , 2015.…”

Section: Introductionmentioning

confidence: 99%

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User acceptance of observation and response charts with a track and trigger system: a multisite staff survey

Elliott

Allen

McKinley

et al. 2016

Journal of Clinical Nursing

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Aims and objectives. To examine user acceptance with a new format of charts for recording observations and as a prompt for responding to episodes of clinical deterioration in adult medical-surgical patients. Background. Improving recognition and response to clinical deterioration remains a challenge for acute healthcare institutions globally. Five chart templates were developed in Australia, combining human factors design principles with a track and trigger system for escalation of care. Two chart templates were previously tested in simulations, but none had been evaluated in clinical practice. Design. Prospective multisite survey of user acceptance of the charts in practice. Methods. New observation and response charts were trialled in parallel with existing charts for 24 hours across 36 adult acute medical-surgical wards, covering 108 shifts, in five Australian states. Surveys were completed by 477 staff respondents, with open-ended comments and narrative from short informal feedback groups providing elaboration and context of user experiences. Results. Respondents were broadly supportive of the chart format and content for monitoring patients, and as a prompt for escalating care. Some concerns were noted for chart size and style, use of ranges to graph vital signs and with specific human factors design features. Information and training issues were identified to improve usability and adherence to chart guidelines and to support improved detection and response for patients with clinical deterioration.Conclusions. This initial evaluation demonstrated that the charts were perceived as appropriate for documenting observations and as a prompt to detect clinical deterioration. Further evaluation after some minor modifications to the chart is recommended.What does this paper contribute to the wider global clinical community?• Implementing practice initiatives to improve recognition and response to clinical deterioration (the afferent limb of the rapid response system) remains a global healthcare challenge This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. Relevance to clinical practice. Explicit training on the principles and rationale of human factors chart design, use of embedded change management strategies and addressing practical issues will improve authentic engagement, staff acceptance and adoption by all clinical users when implementing a similar observation and response chart into practice.

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