Recognising and responding to in‐hospital clinical deterioration: An integrative review of interprofessional practice issues

Allen, Emily; Elliott, Doug; Jackson, Debra

doi:10.1111/jocn.13839

Cited by 25 publications

(28 citation statements)

References 66 publications

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“…A further unanticipated and concerning consequence of implementing C4H was the use of the C4H pathway by nurses. Many reports have highlighted that communication problems between health professionals themselves present barriers to effective escalation of care . The described practice by nurses encouraging parents to use C4H to obtain a medical review or even utilizing C4H themselves seems reflective of such interprofessional communication barriers.…”

Section: Discussionmentioning

confidence: 99%

“…At this point, no specific strategies had been used to address the barrier of overcoming the traditional hospital hierarchy which remains a widely reported issue in escalation of care. [30][31][32][33][34] There were some unexpected findings related to nurse beliefs and behaviours. Despite nurses knowing that there had been only one C4H direct parent MET call since implementation, this concern remained a factor that influenced their decisions to inform parents.…”

Section: Thismentioning

confidence: 99%

“…Many reports have highlighted that communication problems between health professionals themselves present barriers to effective escalation of care. 30,31,33,35 The described practice by nurses encouraging parents to use C4H to obtain a medical review or even utilizing C4H themselves seems reflective of such interprofessional communication barriers. These findings urgently require further exploration.…”

Section: Thismentioning

confidence: 99%

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Parent escalation of care for the deteriorating child in hospital: A health‐care improvement study

Gill

Leslie

Marshall

2019

Health Expectations

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Objective To evaluate the implementation of an intervention for parents to escalate care if concerned about their child's clinical condition. Design Mixed‐methods health‐care improvement approach guided by the Theoretical Domains Framework. Methods Implementation of the ‘Calling for Help’ (C4H) intervention was informed by previously identified barriers and facilitators. Evaluation involved audit, review of clinical deterioration incidents, interviews and focus groups. Setting Australian specialist paediatric hospital. Participants Convenience sample of 75 parents from inpatient areas during the audit, interviews with ten parents who had expressed concern about their child's clinical condition; five focus groups with 35 ward nurses. Main outcome measures Parent awareness and utilization of C4H, parent and nurse views of factors influencing implementation. Results Parent awareness of C4H improved to 35% (25/75). Parent concern was documented prior to 21/174 (12%) clinical deterioration events. All interviewed parents and nurses who participated in focus groups were positive about C4H. Parents preferred to be informed about C4H by nurses, but nurses described this as time‐consuming and selectively chose parents who they believed would benefit most. Parents and nurses described frustrations with and trepidation in escalating care. Nurses had used C4H to expedite urgent medical review. Conclusions There was an improvement in the level of parent awareness of C4H, which was viewed positively by parents and nurses alike. To achieve a high level of parent awareness in a sustainable way, a multifaceted approach is required. Further strategies will be required for parents to feel confident enough to use C4H and to address interprofessional communication barriers.

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Section: Discussionmentioning

confidence: 99%

Section: Thismentioning

confidence: 99%

Section: Thismentioning

confidence: 99%

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Parent escalation of care for the deteriorating child in hospital: A health‐care improvement study

Gill

Leslie

Marshall

2019

Health Expectations

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“…This was particularly visible in situations when the score was low, but the nurses decided to call based on concerns that something was wrong. In a recent review (Allen, Elliott, & Jackson, ), researchers found that using the RRS led to professional reporting hierarchies and could inhibit the effective recognition of and response to clinical deterioration. This is in line with the finding from our review, indicating that the hierarchical hospital culture may influence nurses’ ability to assess and manage patients in crisis.…”

Section: Discussionmentioning

confidence: 99%

The impact of Early Warning Score and Rapid Response Systems on nurses’ competence: An integrative literature review and synthesis

Jensen

Skår

Tveit

2018

Journal of Clinical Nursing

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“…This resulted in C4H information not being prioritized when nurses provided information to parents. Difficulties in attempts to bypass the hierarchy and traditional culture in the hospital system are already well‐recognized barriers to health professionals especially nurses effectively utilizing RRS, but had not been previously reported in the context of parent involvement. This is an ironic finding given that the basis and impetus for implementing a process for parent escalation of care is to reduce the delays related to organizational hierarchical behaviours and poor health professional communication …”

Section: Discussionmentioning

confidence: 99%

Barriers and facilitators to implementing a process to enable parent escalation of care for the deteriorating child in hospital

Gill

Leslie

Marshall

2018

Health Expectations

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ObjectiveTo identify barriers and facilitators to implementing a parent escalation of care process: Calling for Help (C4H).DesignAudits, semi‐structured interviews and focus groups guided by the Theoretical Domains Framework.SettingAustralian paediatric hospital where a parent escalation of care process was introduced in the previous 6 months.ParticipantsFour children, 13 parents, 91 nurses and doctors including Medical Emergency Team (MET) members.Main outcome measuresParent awareness and involvement in escalating care and factors impacting implementation of C4H.ResultsTwo audits identified low level of parent awareness (16/88, 19% and 5/85, 6%). Parent involvement in escalation of care was documented in 11/62 (18%) events. The main facilitators included uniformly positive views that C4H was in the child's best interest, acknowledgement that parents had skills to recognize deterioration and would take action. C4H was considered to add to patient safety and being reviewed by the MET was a patient benefit. Key barriers were the low level of awareness, doubt about parent capabilities, concern about parents’ information overload, anticipated overuse of resources, staff unease about possible repercussions and anticipated difficulty for parents to question staff with potential negative effects on parent‐staff relationships. Overall C4H presents a challenge to traditional hospital hierarchy and culture.ConclusionsAlthough there was a low level of awareness about C4H in practice, there was in‐principle support for the concept. Initial strategies had primarily targeted policy change without taking into account the need for practice and organizational behaviour changes. Using a theoretical approach to identify key factors will enable a targeted approach to implementation.

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Recognising and responding to in‐hospital clinical deterioration: An integrative review of interprofessional practice issues

Abstract: This review presents a unique system-wide approach for exploring how health professionals interprofessionally collaborate in practice to effectively recognise and respond to clinical deterioration.

Cited by 25 publications

References 66 publications

Parent escalation of care for the deteriorating child in hospital: A health‐care improvement study

Parent escalation of care for the deteriorating child in hospital: A health‐care improvement study

The impact of Early Warning Score and Rapid Response Systems on nurses’ competence: An integrative literature review and synthesis

Barriers and facilitators to implementing a process to enable parent escalation of care for the deteriorating child in hospital

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