The effectiveness of education in the recognition and management of deteriorating patients: A systematic review

Connell, Clifford J.; Endacott, Ruth; Jackman, J.A.; Kiprillis, Noelleen; Sparkes, Louise; Cooper, Simon

doi:10.1016/j.nedt.2016.06.001

Cited by 68 publications

(40 citation statements)

References 57 publications

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“…However, the review also concludes that EWS updates require educational approaches that go beyond merely improving knowledge levels and should focus on outcome‐based training (Saab et al, ). The emphasis therefore of any update should be on developing experience and expertise rather than knowledge (Rattray, Crocker, Jones, & Connaghan, ) and simulation training should be used (Connell et al, ) as part of a team collaboration. Multidisciplinary‐focused education programmes have proven effective (Merriel et al, ), and nurses welcome education in collaboration with doctors to develop teamwork and communication relationship (Petersen et al, ).…”

Section: Discussionmentioning

confidence: 99%

“…Developments in education and training using both simulation training, teamwork and communication methods have been found to be beneficial for nurses and have a positive impact on EWS practice (Connell et al, ; Liaw et al, ; Ludikhuize, Jonge, & Goossens, ). In addition, the introduction of electronic systems that alert the critical care team from the patient's score has been shown to assist in improving response times and early patient management (Bellomo et al, ).…”

Section: Introductionmentioning

confidence: 99%

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How do nurses use the early warning score in their practice? A case study from an acute medical unit

Foley

Dowling

2018

Journal of Clinical Nursing

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Aims and objectives:This study aimed to describe how nurses use the early warning score (EWS) in an acute medical ward and their compliance with the EWS and explore their views and experiences of the EWS. Background: early warning score systems have been implemented in response to upward trends in mortality rates. Nurses play a central role in the use of EWS systems. However, barriers to their use have been identified and include behavioural, cultural and organisational approaches to adherence. Improvement strategies including education and training and electronic devices have assisted in compliance with the system. Design:A holistic single descriptive case study design was used. Methods: Data triangulation was used including non-participant observation, semistructured interviews with nurses and document analysis. Nurses were observed using EWS and were subsequently interviewed. Data analysis was guided by systematic text condensation (STC), an approach underpinned by Giorgi's phenomenological method, where meaning units and themes are identified. The study adhered to the consolidated criteria for reporting qualitative research (COREQ) guidelines. Results: Three themes with associated meaning units were found. Protocol Adherence vs. Clinical Judgement addresses nurses' knowledge, skill and experience and patient assessment. Parameter Adjustment and Escalation included parameters not being adjusted or reviewed, junior doctors not being authorised to set parameters and escalation. The final theme Culture highlighted a task-driven approach and deficient communication processes. Conclusion: This study highlights the need for ongoing training, behavioural change and a cultural shift by healthcare professionals and organisations to ensure adherence with EWS escalation protocols. Relevance to clinical practice: Improvements in education and training into recognition, management and communication of a deteriorating patient are required. Also, a cultural shift is needed to improve compliance and adherence with EWS practice. The potential use of electronic data should be explored. K E Y W O R D S acute care, case study, deteriorating patient, early warning score S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Foley C, Dowling M. How do nurses use the early warning score in their practice? A case study from an acute medical unit.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

How do nurses use the early warning score in their practice? A case study from an acute medical unit

Foley

Dowling

2018

Journal of Clinical Nursing

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“…115 However, in the latter, the educational intervention was accompanied by greater use of a MET review, more vital signs documentation and a new TTS. Connell et al 116 included 13 studies evaluating the impact of educational programmes on doctors and nurses and all except one study showed either a change in behaviour or increased knowledge and confidence post training. This review also included the before-and-after study by Fuhrmann et al 114 showing no change in hospital mortality.…”

Section: Continuing Educationmentioning

confidence: 99%

Interventions to reduce mortality from in-hospital cardiac arrest: a mixed-methods study

Hogan

Hutchings

Wulff

et al. 2019

Health Serv Deliv Res

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BackgroundUnchecked patient deterioration can lead to in-hospital cardiac arrest (IHCA) and avoidable death. The National Cardiac Arrest Audit (NCAA) has found fourfold variation in IHCA rates and survival between English hospitals. Key to reducing IHCA is both the identification of patients at risk of deterioration and prompt response. A range of targeted interventions have been introduced but implementation varies between hospitals. These differences are likely to contribute to the observed variation between and within hospitals over time.ObjectiveTo determine how interventions aimed at identification and management of deteriorating patients are associated with IHCA rates and outcomes.DesignA mixed-methods study involving a systematic literature review, semistructured interviews with 60 NHS staff, an organisational survey in 171 hospitals and interrupted time series and difference-in-difference analyses (106 hospitals).SettingEnglish hospitals participating in the NCAA audit.ParticipantsNHS staff (approximately 300) and patients (13 million).InterventionsEducation, track-and-trigger systems (TTSs), standardised handover tools and outreach teams.Main outcome measuresIHCA rates, survival and hospital-wide mortality.Data sourcesNCAA, Hospital Episode Statistics, Office for National Statistics Mortality Statistics.MethodsA literature review and qualitative interviews were used to design an organisational survey that determined how interventions have been implemented in practice and across time. Associations between variations in services and IHCA rates and survival were determined using cross-sectional, interrupted time series and difference-in-difference analyses over the index study period (2009/10 to 2014/15).ResultsAcross NCAA hospitals, IHCAs fell by 6.4% per year and survival increased by 5% per year, with hospital mortality decreasing by a similar amount. A national, standard TTS [the National Early Warning Score (NEWS)], introduced in 2012, was adopted by 70% of hospitals by 2015. By 2015, one-third of hospitals had converted from paper-based TTSs to electronic TTSs, and there had been an increase in the number of hospitals with an outreach team and an increase in the number with a team available at all times. The extent of variation in the uses of educational courses and structured handover tools was limited, with 90% of hospitals reporting use of standardised communication tools, such as situation, background, assessment and recommendation, in 2015. Introduction of the NEWS was associated with an additional 8.4% decrease in IHCA rates and, separately, a conversion from paper to electronic TTS use was associated with an additional 7.6% decrease. However, there was no associated change in IHCA survival or hospital mortality. Outreach teams were not associated with a change in IHCA rates, survival or hospital mortality. A sensitivity analysis restricted to ward-based IHCAs did not alter the findings but did identify an association between increased outreach team intensity in 2015 and IHCA survival.LimitationsThe organisational survey was not able to explore all aspects of the interventions and the contextual factors that influenced them. Changes over time were dependent on respondents’ recall.ConclusionsStandardisation of TTSs and introduction of electronic TTSs are associated with a reduction in IHCAs. The apparent lack of impact of outreach teams may reflect their mode of introduction, that their effect is through providing support for implementation of TTS or that the organisation of the response to deterioration is not critical, as long as it is timely. Their role in end-of-life decision-making may account for the observed association with IHCA survival.Future workTo assess the potential impact of outreach teams at hospital level and patient level, and to establish which component of the TTS has the greatest effect on outcomes.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…Over the past decade, several published studies have examined the effectiveness of educational interventions on early recognition and management of clinical deterioration among nurses (Connell et al, ). Simulation was reported in more than half of these educational interventions.…”

Section: Discussionmentioning

confidence: 99%

“…In crew resource management training, exercises and simulation are employed as approaches to emphasize the importance of human behaviours on safety and error reduction (Flin & Maran, 2015). (Connell et al, 2016). Simulation was reported in more than half of these educational interventions.…”

Section: Ta B L E 6 Multiple Linear Regression Coefficients For Modelmentioning

confidence: 99%

Perception of clinical deterioration cues among medical‐surgical nurses

Orique

Despins

Wakefield

et al. 2019

Journal of Advanced Nursing

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Aim To examine medical‐surgical nurses’ capacity and tendency to perceive cues indicating clinical deterioration and nursing characteristics influencing deterioration cue perception. Design Cross‐sectional, explorative study design. Methods Data were collected over 10 weeks between September–November 2017. Medical‐surgical nurses completed an online survey consisting of a demographic questionnaire, the Occupational Fatigue, Exhaustion Recovery scale and 50 detection trials. Descriptive statistics and statistical tests were used to describe and interpret data. Findings A significant association was found between nurses’ capacity and tendency to perceive deterioration cues. As nurses’ capacity to perceive deterioration cues increased, nurses were more likely to classify patient cues as indicators of deterioration. Fatigue, education, and certification were not identified as characteristics associated with deterioration cue perception. However, experience was observed to significantly influence nurses’ capacity to perceive deterioration cues based on levels of skills acquisition. Conclusion Study findings imply that future research should be directed at determining whether other individual factors and organizational system dynamics influence deterioration cue perception. Impact To better understand how nurses perceive deterioration cues, this study integrated concepts from the Situation Awareness model and Signal Detection Theory. Novice, advanced beginner and competent nurses were found to have a lower capacity to perceive deterioration cues compared with proficient and expert nurses. With simulation increasingly being used as a primary teaching modality in nursing, the development of a simulation‐based signal detection training intervention may be beneficial in enhancing deterioration cue perception.

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The effectiveness of education in the recognition and management of deteriorating patients: A systematic review

Cited by 68 publications

References 57 publications

How do nurses use the early warning score in their practice? A case study from an acute medical unit

How do nurses use the early warning score in their practice? A case study from an acute medical unit

Interventions to reduce mortality from in-hospital cardiac arrest: a mixed-methods study

Perception of clinical deterioration cues among medical‐surgical nurses

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