We Are Not There Yet: A Qualitative System Probing Study of a Hospital Rapid Response System

Abstract

Objectives The capability of a hospital’s rapid response system (RRS) depends on various factors to reduce in-hospital cardiac arrests and mortality. Through system probing, this qualitative study targeted a more comprehensive understanding of how healthcare professionals manage the complexities of RRS in daily practice as well as identifying its challenges. Methods We observed RRS through in situ simulations in 2 wards and conducted the debriefings as focus group interviews. By arranging a separate focus group interview, we included the perspectives of intensive care unit personnel. Results Healthcare professionals appreciated the standardized use of the National Early Warning Score, when combined with clinical knowledge and experience, structured communication, and interprofessional collaboration. However, we identified salient challenges in RRS, for example, unwanted variation in recognition competence, and inconsistent routines in education and documentation. Furthermore, we found that a lack of interprofessional trust, different understandings of RRS protocol, and signs of low psychological safety in the wards disrupted collaboration. To help remedy identified challenges, healthcare professionals requested shared arenas for learning, such as in situ simulation training. Conclusions Through system probing, we described the inner workings of RRS and revealed the challenges that require more attention. Healthcare professionals depend on structured RRS education, training, and resources to operate such a system. In this study, they request interventions like in situ simulation training as an interprofessional educational arena to improve patient care. This is a relevant field for further research. The Consolidated Criteria for Reporting Qualitative Studies Checklist was followed to ensure rigor in the study.

Reduction in omission events after implementing a Rapid Response System: a mortality review in a department of gastrointestinal surgery

“…Challenges in this fundamental limb of the RRS have been frequently reported in the literature [ 12 , 14 ]. In an earlier study from this hospital, NEWS availability in the electronic OM-chart (P3) was reported to make deterioration easier to detect due to the series of time-registered measures highlighted in bright colours when vital signs deviate from normal [ 28 ]. However, ward patients are not continuously monitored; therefore, deterioration can occur between intermittent observations.…”

“…We believe that timely escalations must be a focus for continuous attention to ensure sustainability due to many known challenges [ 14 ]. Alarm fatigue is a known challenge when monitoring patients with serious illnesses and abnormal vital signs over time [ 28 , 31 ]. Furthermore, even when nurses or ward physicians recognise the deterioration, the ward-culture, and the HCPs earlier experiences of how they are treated by the MET during escalation may influence further action [ 14 , 28 ].…”

“…Alarm fatigue is a known challenge when monitoring patients with serious illnesses and abnormal vital signs over time [ 28 , 31 ]. Furthermore, even when nurses or ward physicians recognise the deterioration, the ward-culture, and the HCPs earlier experiences of how they are treated by the MET during escalation may influence further action [ 14 , 28 ]. Resources and ICU capacity are also known to influence HCP responses to patient deterioration [ 14 , 28 , 32 ].…”

Interprofessional Learning in Multidisciplinary Healthcare Teams Is Associated With Reduced Patient Mortality: A Quantitative Systematic Review and Meta-analysis

“…[11][12][13][14][15] Establishing the clinical evidence for the efficacy of IPL is therefore important for achieving better outcomes for patients. 14,16 A recent review study goes further, suggesting that IPL should be repositioned from the margins to the center of healthcare education and training, before and after qualification. 17 However, many in core healthcare disciplines, such as medicine and surgery, remain skeptical of the evidence for the efficacy of IPL.…”

“…Such perceived benefits have led to IPL being promoted widely throughout the world in curricular strategic plans, policy documents from healthcare colleges, and by the World Health Organization 11–15 . Establishing the clinical evidence for the efficacy of IPL is therefore important for achieving better outcomes for patients 14,16 …”