Sage Journals: Discover world-class research

Abstract

Background

Measures exist to improve early recognition of, and response to deteriorating patients in hospital. Despite these, 7% of the deaths reported to the National Reporting and Learning System from acute hospitals in 2015 related to a failure to recognise or respond to deterioration. Interventions have been developed that allow patients and relatives to escalate patient deterioration to a critical care outreach team. However, there is not a strong evidence base for the clinical effectiveness of these interventions, or patients' ability to recognise deterioration.

Aims

The aims of this study were as follows. (a) To identify methods of involving patients in recognising deterioration in hospital, generated by health professionals. (b) To develop and evaluate an identified method of patient involvement in practice, and explore its feasibility and acceptability from the perspectives of patients.

Methods

The study used a mixed-methods design. A measure to capture patient-reported wellness during observation was developed (Patient Wellness Questionnaire) through focus group discussion with health professionals and patients, and piloted on inpatient wards.

Results

There was limited uptake where patients were asked to record ratings of their wellness using the Patient Wellness Questionnaire themselves. However, where the researcher asked patients about their wellness using the Patient Wellness Questionnaire and recorded their responses during observation, this was acceptable to most patients.

Conclusions

This study has developed a measure that can be used to routinely collect patient-reported wellness during observation in hospital and may potentially improve early detection of deterioration.

Keywords

acute care clinical deterioration communication patient involvement patient safety

Get full access to this article

View all access options for this article.

References

Alam

Hobbelink

van Tienhoven

, et al.(2014) The impact of the use of Early Warning Score (EWS) on patient outcomes: A systematic review. Resuscitation 85: 587–594.

Albutt

O'Hara

Conner

, et al.(2016) Is there a role for patients and their relatives in escalating clinical deterioration in hospital? A systematic review. Health Expect. Epub ahead of print, 26 October 2016. DOI:10.1111/hex.12496.

Benyamini

(2003) Gender differences in the self-rated health-mortality association: Is it poor self-rated health that predicts mortality or excellent self-rated health that predicts survival?. Gerontologist 43(3): 396–405.

Bowen

(2008) Naturalistic inquiry and the saturation concept: A research note. Qualitative Research 8(1): 137–152.

Braun

Clarke

(2006) Using thematic analysis in psychology. Qualitative Research in Psychology 3(2): 77–101.

Browne

(1995) On the use of a pilot sample for sample size determination. Statistics in Medicine 14: 1933–1940.

Chen

Kemper

Odetola

, et al.(2012) Prevalence, characteristics, and opinions of pediatric rapid response teams in the United States. Hospital Paediatrics 2(3): 133–140.

Cresswell

Plano Clark

(2011) Designing and Conducting Mixed Method Research, 2nd ed. Thousand Oaks, CA: SAGE.

De Meester

Das

Hellemans

, et al.(2013) Impact of a standardized nurse observation protocol including MEWS after Intensive Care Unit discharge. Resuscitation 84: 184–188.

10.

Fetters MD, Curry LA and Creswell JW (2013) Achieving Integration in Mixed Methods Designs–Principles and Practices. Health Services Research 48(6): 2134–2156.

11.

Frankenberg

Jones

(2004) Self-rated health and mortality: Does the relationship extend to a low income setting?. Journal of Health and Social Behavior 45(4): 441–452.

12.

Frost

Chapman

Aneman

, et al.(2015) Hospital outcomes associated with introduction of a two-tiered response to the deteriorating patient. Critical Care Resuscitation 17(2): 77–82.

13.

Gill

Leslie

Marshall

(2016) The impact of implementation of family initiated escalation of care for the deteriorating patient in hospital: A systematic review. Worldviews Evidence Based Nursing 13(4): 303–313.

14.

Green

Lander

Snyder

(2018) Comparison of the Between the Flags calling criteria to the MEWS, NEWS and the electronic Cardiac Arrest Risk Triage (eCART) score for the identification of deteriorating ward patients. Resuscitation 123: 86–91.

15.

Idler

Benyamini

(1997) Self-rated health and mortality: A review of twenty-seven community studies. Journal of Health and Social Behavior 38(1): 21–37.

16.

Johnston

Arora

King

, et al.(2015) A systematic review to identify the factors that affect failure to rescue and escalation of care in surgery. Surgery 157(4): 752–763.

17.

Jonsson

Jonsdottir

Moller

, et al.(2011) Nursing documentation prior to emergency admissions to the intensive care unit. Nursing in Critical Care 16: 164–169.

18.

King

(2010) Josie's Story: A mother's inspiring crusade to make medical care safer, New York, NY: Grove Press.

19.

Kondracki

Wellman

Amundson

(2002) Content analysis: Review of methods and their applications in nutrition education. Journal of Nutrition Education and Behavior 34(4): 224–230.

20.

Lawton R and Armitage G (2012) The role of the patient in clinical safety. Available at: http://www.health.org.uk/sites/default/files/TheRoleOfThePatientInClinicalSafety.pdf (accessed 23 March 2017).

21.

National Confidential Enquiry into Patient Outcome and Death (2005) An Acute Problem? Available at: http://www.ncepod.org.uk/2005report/introduction.html (accessed 15 Feb 2017).

22.

NHS Confederation (2016) Key statistics on the NHS. Available at: http://www.nhsconfed.org/resources/key-statistics-on-the-nhs (accessed 20 April 2017).

23.

NHS Improvement (2016) The Adult Patient Who is Deteriorating: Sharing learning from literature, incident reports and root cause analysis investigations. Available at: https://improvement.nhs.uk/documents/176/Deterioration_in_adults_report_7july.pdf (accessed 21 Sept 2018).

24.

O'Cathain

Murphy

Nicholl

(2007) Why, and how, mixed methods research is undertaken in health services research in England: A mixed methods study. BMC Health Services Research 7: 85.

25.

O'Cathain

Murphy

Nicholl

(2008) The quality of mixed methods studies in health services research. Journal of Health Services Research and Policy 13(2): 92–98.

26.

Patel

Jones

Jiggins

, et al.(2011) Does the use of a track and trigger warning system reduce mortality in trauma patients?. Injury 42: 1455–1459.

27.

Rainey

Ehrich

Mackintosh

, et al.(2015) The role of patients and their relatives in ‘speaking up’ about their own safety-a qualitative study of acute illness. Health Expectations 18: 392–405.

28.

Raymond

Kyzer

Copper

, et al.(2009) South Carolina patient safety legislation: The impact of the Lewis Blackman Hospital Patient Safety Act on a large teaching hospital. Journal of the South Carolina Medical Association 105(1): 12–15.

29.

Roland

(2015) But I told you she was ill! The role of families in preventing avoidable harm in children. BMJ Quality Safety 24: 186–187.

30.

Royal College of Physicians (2012) National Early Warning Score (NEWS). Standardising the assessment of acute-illness severity in the NHS. Available at: file:///H:/MyDocuments/Downloads/National%20Early%20Warning%20Score%20(NEWS)%20-%20Standardising%20the%20assessment%20of%20acute-illness%20severity%20in%20the%20NHS_0%20(2).pdf (accessed 1 April 2019).

31.

Soar

Subbe

(2012) Identifying the patient at risk of deterioration, intensive care unit admission or cardiac arrest: Stop predicting, start preventing. Critical Care Medicine 40: 2243–2244.

32.

Stelfox

Bagshaw

Gao

(2014) Characteristics and outcomes for hospitalized patients with recurrent clinical deterioration and repeat medical emergency team activation. Critical Care Medicine 42: 1601–1609.

33.

Tausch

Menold

(2016) Methodological aspects of focus groups in health research. Global Qualitative Nursing Research 3 DOI: 10.1177/2333393616630466.

34.

Whitehead

Julious

Cooper

, et al.(2016) Estimating the sample size for a pilot randomised trial to minimise the overall trial sample size for the external pilot and main trial for a continuous outcome variable. Statistical Methods in Medical Research 25(3): 1057–1073.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.13 MB

0.14 MB

0.09 MB

Involving patients in recognising clinical deterioration in hospital using the Patient Wellness Questionnaire: A mixed-methods study