Abstract
BackgroundVital signs are the primary indicator of physiological status and for determining the need for urgent clinical treatment. Yet, if physiological signs of deterioration are missed, misinterpreted or mismanaged, then critical illness, unplanned intensive care admissions, cardiac arrest and death may ensue. Although evidence demonstrates the benefit of early recognition and management of deteriorating patients, failure to escalate care and manage deteriorating patients remains a relatively frequent occurrence in hospitals.Methods/designA pragmatic cluster-randomised controlled trial design will be used to measure clinical effectiveness and cost of a facilitation intervention to improve nurses’ vital sign measurement, interpretation, treatment and escalation of care for patients with abnormal vital signs. A cost consequence analysis will evaluate the intervention cost and effectiveness, and a process evaluation will determine how the implementation of the intervention contributes to outcomes. We will compare clinical outcomes and costs from standard implementation of clinical practice guidelines (CPGs) to facilitated implementation of CPGs. The primary outcome will be adherence to the CPGs by nurses, as measured by escalation of care as per organisational policy. The study will be conducted in four Australian major metropolitan teaching hospitals. In each hospital, eight to ten wards will be randomly allocated to intervention and control groups. Control wards will receive standard implementation of CPGs, while intervention wards will receive standard CPG implementation plus facilitation, using facilitation methods and processes tailored to the ward context. The intervention will be administered to all nursing staff at the ward level for 6 months. At each hospital, two types of facilitators will be provided: a hospital-level facilitator as the lead; and two ward-level facilitators for each ward.DiscussionThis study uses an innovative, networked approach to facilitation to enable uptake of CPGs. Findings will inform the intervention utility and knowledge translation measurement approaches. If successful, the study methodology and intervention has potential for translation to other health care standards.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12616000544471p
Highlights
Vital signs are the primary indicator of physiological status and for determining the need for urgent clinical treatment
Failure to call the rapid response systems (RRS) for patients fulfilling activation criteria occurs despite the release of international guidelines [9, 10] and the prioritisation of Standard 9 as one of the ten National Quality and Safety Health Service (NQSHS) Standards required for Australian hospital accreditation from 2011 [11]
Cardiac arrest, unplanned intensive care admissions and death may result if physiological signs of deterioration are missed, misinterpreted or mismanaged
Summary
Vital signs are the primary indicator of physiological status and for determining the need for urgent clinical treatment. If physiological signs of deterioration are missed, misinterpreted or mismanaged, critical illness, unplanned intensive care admissions, cardiac arrest and death may ensue. If physiological signs of deterioration are missed, misinterpreted or mismanaged, serious adverse events (SAEs) such as critical illness, cardiac arrest, unplanned intensive care admissions and death may result. Failure to call the RRS for patients fulfilling activation criteria occurs despite the release of international guidelines [9, 10] and the prioritisation of Standard 9 (recognition and response to clinical deterioration in acute health care) as one of the ten National Quality and Safety Health Service (NQSHS) Standards required for Australian hospital accreditation from 2011 [11].
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