To identify the factors that influence the recognizing and responding to adult patient deterioration in acute hospitals

Abstract

Aims To identify factors that influence recognition and response to adult patient deterioration in acute hospitals. Design A mixed‐studies systematic review. Data Sources CINAHL, Medline, and Web of Science were searched for relevant literature published between 2007 – 2018. Review Methods Studies were critically appraised, data extracted and thematically analysed. Results Thirteen papers met the inclusion criteria. Three main themes were identified: (a) Knowledge and understanding of clinical deterioration; (b) Organizational factors; managing deterioration and staffing levels; and (c) Communication; inter‐professional relationships and professional‐patient communication. Conclusion Despite national guidelines, the review findings suggest that the recognition and response to adult patient deterioration in acute hospital settings is sub‐optimal. A multitude of factors influencing the recognition and response to adult patient deterioration emerged from the findings. Impact Patients are receiving sub‐optimal care due to failure in recognizing and responding to patient deterioration in an appropriate and timely manner. Nurses lack knowledge and understanding of deterioration. Organizational factors contribute to inadequate care and communication among professionals was highlighted as challenging. The factors that influence the recognizing and responding to patient deterioration in acute hospitals are multi‐faceted, however this review highlights immediate recommendations for professionals in the acute care setting.

Patterns of behaviour in nursing staff actioning the afferent limb of the rapid response system (RRS): A focused ethnography

“…Our finding that respiratory rate is often under reported, leading to a potential underestimation of patient acuity, is consistent with other research including a study that compared respiratory rate measured by an electronic wearable device to respiratory rate measured by nurses (Weenk et al., 2019). Cited explanations for this unexpected behaviour include a lack of skill in obtaining the measurement and a lack of knowledge of its importance (Treacy & Stayt, 2019). Use of wearable continuous respiratory rate monitoring devices offer one solution to this pervasive problem (Weenk et al., 2019).…”

“…Our findings align to other published literature, also reporting the problem of incomplete vital signs in an EHRS context (Stevenson, Israelsson, Nilsson, Petersson, & Bath, 2016). This unexpected behaviour could be the result of a lack of knowledge among nursing staff about the importance of an aggregate NEWS in determining risk, or lack of awareness of the potential consequences of not completing a thorough and timely patient assessment (Treacy & Stayt, 2019; Wood et al., 2019).…”

“…Unlike the other vital signs entered into NEWS, the respiratory rate is typically not measured using electronic equipment and must be measured visually by a healthcare provider (Badawy, Nguyen, Clark, Halm, & Makam, 2017). Despite its importance, there is evidence that recorded respiratory rates are frequently inaccurate (Badawy et al., 2017; Treacy & Stayt, 2019). Based on this evidence, we elected to compare the respiratory rate recorded on NEWS with the respiratory rate counted by the researcher in situ.…”

“…This lack of compliance has been termed “afferent limb failure” (ALF) (Johnston, Arora, King, Stroman, & Darzi, 2014; Trinkle & Flabouris, 2011). There is an abundance of literature describing the potential causes of ALF (Olsen, Søreide, Hillman, & Hansen, 2019; Treacy & Stayt, 2019; Wood, Chaboyer, & Carr, 2019) but paucity of work reporting interventions to target it (Bucknall et al., 2017; Connell et al., 2016; Duff, Massey, Gooch, & Wallis, 2018). Further, most of the interventions described are educational with methodological limitations including risks of bias and/or consistently poor detailing of the development process, suggesting that these interventions may have been developed pragmatically (i.e., based on clinician or researcher intuition) rather than using a replicable method.…”

An examination of the nature and characteristics of patients readmitted to acute care from inpatient brain injury rehabilitation

“…Without this there is a mismatch between what is expected and the available resources, which has an impact on the capacity for practice change in preventing RTAC. This is particularly relevant regarding implicit rationing of nursing care resulting in missed nursing care (Jones, Hamilton, Sportsman, Gemeinhardt, & Carryer, 2014) or intentional omissions in nursing care (Treacy & Stayt, 2019) as nurses need to ration the care they provide based on patient acuity and routine tasks (e.g., medication administration). For instance, nurse staffing levels have a negative impact on nursing’s capacity to recognise and respond to patient deterioration in acute hospitals (Treacy & Stayt, 2019) and missed nursing care has been identified as a predictor for patient falls (Hessels, Paliwal, Weaver, Siddiqui, & Wurmser, 2019).…”