Summary
Appropriate care escalation requires the detection and communication of in-hospital patient deterioration. Although deterioration in the ward environment is common, there continue to be patient deaths where problems escalating care have occurred. Learning from the everyday work of health care professionals (work-as-done) and identifying performance variability may provide a greater understanding of the escalation challenges and how they overcome these.
The aims of this study from Ede et al. were to i) develop a representative model detailing escalation of care ii) identify performance variability that may negatively or positively affect this process and iii) examine linkages between steps in the escalation process.
Content
What is already known
- The escalation of patients following deterioration remains problematic and improvements are required.
- Nationally adopted escalation protocols (NEWS2) do not entirely complement the way in which clinical staff escalate care successfully in variable work systems.
- There is a constant realignment between protocol-driven care (work-as-prescribed) and actual delivered care (work-as-done) as standardised processes are often theoretical in their nature and overestimate system stability.
What this paper adds
- Experts identified stark differences between work-as-prescribed (NEWS2 protocols) and work-as-done (everyday escalation tasks) with 28 % (9/32) of escalation tasks described as cognitively difficult.
- Three out of the nine variable tasks (‘making the critical decision to escalate’, ‘synthesising all data points’, and ‘identifying interim actions’) were closely coupled within FRAM Model 2b indicating potential points of weakness in the escalation process.
- The ability to efficiently synthesise data is a central task during escalation, and when effective, allows staff to use creative strategies to manage deterioration.
Recommended Comments
Create an account or sign in to comment