Study protocol for evaluating the implementation and effectiveness of an emergency department longitudinal patient monitoring system using a mixed-methods approach

Abstract

BackgroundEarly detection of patient deterioration is a key element of patient safety as it allows timely clinical intervention and potential rescue, thus reducing the risks of serious patient safety incidents. Longitudinal patient monitoring systems have been widely recommended for use to detect clinical deterioration. However, there is conflicting evidence on whether they improve patient outcomes. This may in part be related to variation in the rigour with which they are implemented and evaluated. This study aims to evaluate the implementation and effectiveness of a longitudinal patient monitoring system designed for adult patients in the unique environment of the Emergency Department (ED).MethodsA novel participatory action research (PAR) approach is taken where socio-technical systems (STS) theory and analysis informs the implementation through the improvement methodology of ‘Plan Do Study Act’ (PDSA) cycles. We hypothesise that conducting an STS analysis of the ED before beginning the PDSA cycles will provide for a much richer understanding of the current situation and possible challenges to implementing the ED-specific longitudinal patient monitoring system. This methodology will enable both a process and an outcome evaluation of implementing the ED-specific longitudinal patient monitoring system. Process evaluations can help distinguish between interventions that have inherent faults and those that are badly executed.DiscussionOver 1.2 million patients attend EDs annually in Ireland; the successful implementation of an ED-specific longitudinal patient monitoring system has the potential to affect the care of a significant number of such patients. To the best of our knowledge, this is the first study combining PAR, STS and multiple PDSA cycles to evaluate the implementation of an ED-specific longitudinal patient monitoring system and to determine (through process and outcome evaluation) whether this system can significantly improve patient outcomes by early detection and appropriate intervention for patients at risk of clinical deterioration.

Evaluating the safety and patient impacts of an artificial intelligence command centre in acute hospital care: a mixed-methods protocol

“…A mixed-method approach is well suited to study complexity interventions 28 and the complex adaptive systems to which they are applied. Mixed-method approaches have been used to study information flow and organisational networks, 29 integration of organisational interventions, 30 31 effectiveness of service models, 32 and how Open access health information technology affects communication, 33 patient monitoring, [34][35][36] care provision 37 and clinical decision making. 38 Our study comprises five substudies across five work streams (figure 1).…”

Developing outcome, process and balancing measures for an emergency department longitudinal patient monitoring system using a modified Delphi

“…A recent systematic review found that early warning systems ‘seem to predict adverse outcomes in adult patients of varying acuity presenting to the ED but there is a lack of high quality comparative studies to examine the effect of using early warning systems on patient outcomes’ [6]. There is also a lack of published measures for evaluating the effectiveness of longitudinal patient monitoring systems in the ED setting and the challenges of developing such measures have been outlined [7].…”

“…The Irish National Emergency Medicine Programme (EMP), aimed at improving the safety and quality of ED patient care, developed and piloted an ED-specific longitudinal patient monitoring system known as ED-ACE where ACE is an acronym for Adult Clinical Escalation. This study is part of a larger research programme, which saw the first full-scale iterative implementation of ED-ACE in a large urban acute hospital [7]. The main objective of this study was to develop a consensus among key stakeholders in the hospital frontline healthcare staff, quality and safety (Q&S) experts and health system researchers for outcome, process and balancing measures to measure the effectiveness of ED-ACE.…”

Programa educativo sobre registro da pressão arterial em serviço hospitalar de emergência: um estudo de intervenção

“…O método auscultatório utilizando manômetros de mercúrio ou aparelhos aneróides é considerado um procedimento de difícil execução em pacientes atendidos em salas de emergência, principalmente devido à dificuldade da ausculta e da interpretação dos sons de Korotkoff (KARNATH, 2002;WARD;LANGTON, 2007).…”

“…A grande procura por atendimento médico em unidades de emergência favorece a superlotação dos hospitais, com aumento da carga de trabalho e comprometimento da qualidade da assistência, uma vez que o acesso da equipe multiprofissional ao paciente é prejudicado pela demanda de atividades (WARD et al, 2017).…”