Study Finds Clinicians Support Consumers as First Reporters of Early Patient Deterioration in Hospital
March 28 2024 - 12:03PM
Detection of early patient deterioration in the hospital can lead
to timely intervention and improved outcomes. Patients themselves,
as well as family members and bedside visitors familiar with the
patient’s condition can play a critical role in detecting patient
deterioration.
A new study in the April 2024 issue of The Joint Commission
Journal on Quality and Patient Safety (JQPS), investigates
clinicians’ views on consumer reporting (by patients, family
members or visitors) of early patient deterioration through an
established hospital consumer-initiated escalation-of-care (CIEoC)
system. Two activation pathways (direct and indirect) are available
for consumers to report patient deterioration and alert the rapid
response system (RRS) for early emergency medical treatment in the
CIEoC system:
- Direct activation provides consumers with access to the RRS to
report/seek treatment for deteriorating patients.
- Indirect activation guides consumers to report their concerns
to healthcare staff who decide when to call the RRS.
A research team based at Flinders University, co-funded by the
Government of South Australia’s Southern Adelaide Local Health
Network and Flinders University, undertook the study. The
researchers administered a paper survey containing six open-ended
questions to new graduate-level to senior-level nurses and
physicians at Flinders Medical Centre, Bedford Park, Australia, and
Noarlunga Hospital, Noarlunga Centre, Australia. They analyzed the
data with a matrix-style framework and six steps of thematic
analysis.
A total of 244 clinicians (198 nurses and 46 physicians)
provided their views on the CIEoC system. Six major themes and
subthemes emerged, including:
- Clinicians support consumer reporting and feel consumers are
ideally positioned to recognize early deterioration and raise
concerns about it.
- Management support is required for the consumer escalation
process to be effective.
- Some clinicians feel consumers who raise non-urgent concerns
delay care to others and increase workload. While other clinicians
report a decrease in workload through earlier reporting of
deterioration.
- Educating consumers and staff on escalation protocol is a
requirement for success.
- There is a need to build consumer confidence to speak up.
- There is a need to address barriers to consumer
escalation.
Clinicians’ use of interactive communication skills to encourage
consumer participation in the CIEoC system was highlighted. To that
end, updating clinicians annually on consumer participation in the
escalation of care through multidisciplinary education, simulation
scenarios and education videos was recommended. The clinicians also
indicated a range of educational materials on the
escalation-of-care process to boost consumer knowledge and
confidence, particularly amongst consumers with different
communication capabilities.
Also featured in the April issue are:
- Implementation of a Continuous Patient Monitoring System in the
Hospital Setting: A Qualitative Study (Brigham and Women’s
Hospital, Boston)
- Implementing Multiple Digital Technologies in Health Care:
Seeing the Unintended Consequences for Patient Safety
(editorial)
- Standardizing Patient Safety Event Reporting between Care
Delivered or Purchased by the Veterans Health Administration
(Veterans Health Administration)
- National Survey of Patient Safety Experiences in Hospital
Medicine During the COVID-19 Pandemic (national survey of Society
of Hospital Medicine members)
- Harnessing In Situ Simulation to Identify Human Errors and
Latent Safety Threats in Adult Tracheostomy Care (Albert Einstein
College of Medicine, New York City)
- Evaluation of Objective Appropriateness Criteria for Daily Labs
in General Medicine Inpatients (Kirk Kerkorian School of Medicine
at University of Nevada, Las Vegas)
As part of the 50th anniversary of JQPS, a special collection of
articles featuring past publications on antibiotic stewardship also
are in the April issue, along with these new articles:
- Leveraging Health Systems to Expand and Enhance Antibiotic
Stewardship in Outpatient Settings (commentary)
- Advancing Antibiotic Stewardship: Interviews with Dr. Arjun
Srinivasan and Dr. Payal Patel (interview)
For more information, please visit the JQPS website.
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Note for editors
The article is “Opinions of Nurses and Physicians on a Patient–,
Family–, and Visitor–Activated Rapid Response System in Use Across
Two Hospital Settings,” by Lindy King, PhD; Stanislav Minyaev, BN
(Hons); Hugh Grantham, MBBS; and Robyn A Clark, PhD. The article
appears in The Joint Commission Journal on Quality and Patient
Safety (JQPS), volume 50, number 4 (April 2024), published by
Elsevier.
The Joint Commission Journal on Quality and Patient
Safety
The Joint Commission Journal on Quality and Patient
Safety (JQPS) is a peer-reviewed journal providing healthcare
professionals with innovative thinking, strategies and practices in
improving quality and safety in healthcare. JQPS is the official
journal of The Joint Commission and Joint Commission Resources,
Inc. Original case studies, program or project reports,
reports of new methodologies or the new application of
methodologies, research studies, and commentaries on issues and
practices are all considered.
Katie Bronk
The Joint Commission
630-792-5175
kbronk@jointcommission.org