Critical care clinician perceptions of factors leading to Medical Emergency Team review

Judy Currey, Josh Allen, Daryl Jones

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: The introduction of rapid response systems has reduced the incidence of in-hospital cardiac arrest; however, many instances of clinical deterioration are unrecognised. Afferent limb failure is common and may be associated with unplanned intensive care admissions, heightened mortality and prolonged length of stay. Patients reviewed by a Medical Emergency Team are inherently vulnerable with a high in-hospital mortality. Objective: To explore perceptions of intensive care unit (ICU) staff who attend deteriorating acute care ward patients regarding current problems, barriers and potential solutions to recognising and responding to clinical deterioration that culminates in a Medical Emergency Team review. Methods: A descriptive exploratory design was used. Registered intensive care nurses and medical staff (N = 207) were recruited during a professional conference using purposive sampling for experience in attending deteriorating patients. Written response surveys were used to address the study aim. Data were analysed using content analysis. Results: Four major themes were identified: Governance, Teamwork, Clinical Care Delivery and End of Life Care. Participants perceived there was a lack of sufficient and senior staff with the required theoretical knowledge; and inadequate assessment and critical thinking skills for anticipating, recognising and responding to clinical deterioration. Senior doctors were perceived to inappropriately manage End of Life Care issues and displayed Teamwork behaviours rendering ward clinicians feeling fearful and intimidated. A lack of System and Clinical Governance hindered identification of clinical deterioration. Conclusions: To improve patient safety related to recognising and responding to clinical deterioration, suboptimal care due to professionals' knowledge, skills and behaviours need addressing, along with End of Life Care and Governance.

Original languageEnglish
Pages (from-to)87-92
Number of pages6
JournalAustralian Critical Care
Volume31
Issue number2
DOIs
Publication statusPublished - Mar 2018

Keywords

  • Clinical deterioration
  • End of Life Care
  • Governance
  • Medical Emergency Team
  • Patient assessment
  • Patient safety
  • Rapid response system
  • Rapid response team
  • Risk management
  • Teamwork

Cite this

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abstract = "Background: The introduction of rapid response systems has reduced the incidence of in-hospital cardiac arrest; however, many instances of clinical deterioration are unrecognised. Afferent limb failure is common and may be associated with unplanned intensive care admissions, heightened mortality and prolonged length of stay. Patients reviewed by a Medical Emergency Team are inherently vulnerable with a high in-hospital mortality. Objective: To explore perceptions of intensive care unit (ICU) staff who attend deteriorating acute care ward patients regarding current problems, barriers and potential solutions to recognising and responding to clinical deterioration that culminates in a Medical Emergency Team review. Methods: A descriptive exploratory design was used. Registered intensive care nurses and medical staff (N = 207) were recruited during a professional conference using purposive sampling for experience in attending deteriorating patients. Written response surveys were used to address the study aim. Data were analysed using content analysis. Results: Four major themes were identified: Governance, Teamwork, Clinical Care Delivery and End of Life Care. Participants perceived there was a lack of sufficient and senior staff with the required theoretical knowledge; and inadequate assessment and critical thinking skills for anticipating, recognising and responding to clinical deterioration. Senior doctors were perceived to inappropriately manage End of Life Care issues and displayed Teamwork behaviours rendering ward clinicians feeling fearful and intimidated. A lack of System and Clinical Governance hindered identification of clinical deterioration. Conclusions: To improve patient safety related to recognising and responding to clinical deterioration, suboptimal care due to professionals' knowledge, skills and behaviours need addressing, along with End of Life Care and Governance.",
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Critical care clinician perceptions of factors leading to Medical Emergency Team review. / Currey, Judy; Allen, Josh; Jones, Daryl.

In: Australian Critical Care, Vol. 31, No. 2, 03.2018, p. 87-92.

Research output: Contribution to journalArticleResearchpeer-review

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