Title

A mixed-method study to evaluate the effectiveness of a policy-driven tool to improve the recognition of and response to clinical deterioration in acute care

Author Identifiers

Tania Beament

https://orcid.org/0000-0002-9598-5601

Date of Award

2022

Degree Type

Thesis

Degree Name

Doctor of Philosophy

School

School of Nursing and Midwifery

First Advisor

Di Twigg

Second Advisor

Mandy Towell- Barnard

Abstract

Background: Contemporary literature identifies that clinical deterioration in the acute care setting requires an optimum level of management and that the failure to recognise this deterioration and respond effectively results in increased mortality rates. The early detection of clinical deterioration and the successful rescue of a patient relies heavily on the effectiveness of hospital systems, communication systems and multidisciplinary collaboration.

Objectives: To evaluate the effectiveness of the strategies implemented to improve the escalation of care for patients who deteriorate in hospital. Specifically, the study examined the introduction of a revised observation chart, the experiences of nurses in using the chart, and whether its use resulted in the appropriate escalation of care.

Method: A mixed-methodology approach combining a longitudinal study design with cross-sectional data collection. A quantitative research method was adopted to extract the results from the medical records of patients who had experienced a Medical Emergency Team (MET) call and establish the rate of compliance with the new policy. Patient information sourced from administrative datasets, including discharge abstracts extracted from the hospital's morbidity system and MET call database, were used to determine changes in the rates of MET calls and mortality pre- and post- policy implementation. Qualitative data collection involved focus group discussions on nurses’ experiences of implementing the policy and use of the Adult Observation Response Chart tool. The study was undertaken in the multi-day wards at one of Western Australia’s tertiary hospitals, where a new escalation policy was implemented as part of the State healthcare policy for the recognition of, and response to, the deteriorating patient.

Results: A statistically significant increase in the rate of MET calls in the post-policy intervention period compared to the pre-policy intervention phase was observed, the odds increasing by 12% post-policy intervention. Additionally, the study found a strong correlation between the number of MET calls and the Charlson Index Score (the higher the Charlson Index Score, the more likely a MET call was made). Mortality rate was not significantly different between the two periods after adjustment for other relevant factors. Three major themes were identified: chart design, communication, and the impact of the policy implementation on nurses and patients.

Conclusion: Recognising, responding to, and managing the deteriorating patient is complex, challenging, and multifaceted. The study highlighted the need for effective strategies to support the recognition of clinical deterioration and response in critical situations to enhance patient safety, optimise resources and positively change practice. Findings from the study emphasised the challenges faced when implementing a new policy leading to a change in practice. Recommendations include the refinement of policy and removal of barriers that can impact the implementation of evidence-based practice and the opportunity to improve patient outcomes.

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