期刊论文详细信息
BMJ Open Quality
Human factors in escalating acute ward care: a qualitative evidence synthesis
article
Jody Ede1  Tatjana Petrinic3  Verity Westgate4  Julie Darbyshire4  Ruth Endacott2  Peter J Watkinson4 
[1] Adult Intensive Care Unit , Oxford University Hospitals NHS Foundation Trust;Plymouth University;Bodleian Health Care Libraries , University of Oxford;Nuffield Department of Clinical Neurosciences , University of Oxford;School of Nursing & Midwifery , Monash University
关键词: continuous quality improvement;    critical care;    decision making;    human factors;    medical education;   
DOI  :  10.1136/bmjoq-2020-001145
学科分类:药学
来源: BMJ Publishing Group
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【 摘 要 】

Background Identifying how human factors affect clinical staff recognition and managment of the deteriorating ward patient may inform process improvements. We systematically reviewed the literature to identify (1) how human factors affect ward care escalation (2) gaps in the current literature and (3) critique literature methodologies.Methods We undertook a Qualitative Evidence Synthesis of care escalation studies. We searched MEDLINE, EMBASE and CINHAL from inception to September 2019. We used the Critical Appraisal Skills Programme and the Grading of Recommendations Assessment-Development and Evaluation and Confidence in Evidence from Reviews of Qualitative Research tool to assess study quality.Results Our search identified 24 studies meeting the inclusion criteria. Confidence in findings was moderate (20 studies) to high (4 studies). In 16 studies, the ability to recognise changes in the patient’s condition (soft signals), including skin colour/temperature, respiratory pattern, blood loss, personality change, patient complaint and fatigue, improved the ability to escalate patients. Soft signals were detected through patient assessment (looking/listening/feeling) and not Early Warning Scores (eight studies). In contrast, 13 studies found a high workload and low staffing levels reduced staff’s ability to detect patient deterioration and escalate care. In eight studies quantifiable deterioration evidence (Early Warning Scores) facilitated escalation communication, particularly when referrer/referee were unfamiliar. Conversely, escalating concerning non-triggering patients was challenging but achieved by some clinical staff (three studies). Team decision making facilitated the clinical escalation (six studies).Conclusions Early Warning Scores have clinical benefits but can sometimes impede escalation in patients not meeting the threshold. Staff use other factors (soft signals) not captured in Early Warning Scores to escalate care. The literature supports strategies that improve the escalation process such as good patient assessment skills.PROSPERO registration number CRD42018104745.

【 授权许可】

CC BY-NC|CC BY|CC BY-NC-ND   

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