Acute Ward Setting Research Articles

2269 Preventing frailty crises: improving the care of frail patients in an acute hospital Ward setting

Abstract Introduction Frailty is common in hospitalised older patients and hospitalisation can lead to negative outcomes. Our study aimed to provide insights into current decision-making processes on treatment, care and discharge by clinical teams. Methods We conducted a prospective cohort study in frail older patients ≥65 years old admitted to acute medical and surgical wards. Clinical Frailty Scale ≥5 was used to identify frail patients and process mapping was undertaken to identify common themes, trajectories and potentially modifiable factors. We followed patient journeys from admission to discharge and examined factors contributing to longer hospitalisation. We documented existing processes, environmental, system and clinical factors influencing patient care. Comprehensive geriatric assessments identified underlying geriatric syndromes and where gaps in management were identified, we recommended frailty interventions. Results Fifteen patients provided informed consent, of whom 73% were female and average age 80 years, ranging 69–95 years. 67% were frail (CFS 5–6) and 33% were severely frail (CFS 7–9). Most patients were sarcopenic with a SARC-F score of ≥4 and had functional and gait impairment. 60% were underweight (BMI <22). Process mapping revealed gaps in frailty-focused care and included delayed transfer to acute wards, delayed investigations, and multiple unidentified geriatric syndromes which were prevalent in this cohort. Patients fell into three broad groups, short (1–6 days), intermediate (7–14 days), or long (>14 days) length of stay and delays in discharge-planning were common, mean of 4.17 days, as were delays in identification of a caregiver. Recommendations for community support services were provided to >50% patients. Conclusion Our study shows that mapping the frail patient’s journey can identify gaps in existing processes and opportunities for improvement and collaboration. Integrating geriatric care into general wards could improve patient outcomes. We aim to use this work to guide frailty-attuned care for hospitalised older patients.

Implementing a medication lubricant for pill dysphagia on an acute care ward using Plan-Do-Study-Act cycles

BackgroundPill dysphagia, the difficulty in swallowing solid oral medications, is a common problem that can affect medication adherence and increase pill modifications. Current practices of crushing medications or using food...

A quality improvement project to establish accuracy in completing Early Warning Score chart and appropriate clinical response depending on the score in acute care wards at Asiri Surgical Hospital

Failure or delay in recognition of acutely deteriorating patients in acute care ward setting leads to preventable morbidity, cardiac arrest, and death. Assessment and responding to Early Warning Score (EWS) adapted from National Early Warning Score 2 is implemented at Asiri Surgical Hospital to capture these patients early and escalate their care appropriately. Though a colour-coded EWS chart and a hospital policy are available, gaps in accurate recording, monitoring, and triggering were reported. Thus, a quality improvement project was conducted with the aim of establishing more than 80% accuracy in completing the EWS chart and appropriate clinical response to EWS score in acute care wards at Asiri Surgical Hospital by August 2022.A multidisciplinary team performed a series of Plan-Do-Study-Act cycles focusing on correct documentation and calculation of EWS score and appropriate monitoring and escalation of care. Key drivers for hindering the pathway were identified and addressed. Over the course of the project, correct recording improved from 81.25% to 99.4%, accurate calculation of total EWS score had improved from 79% to 88%, patients who received recommended monitoring as triggered by EWS score improved from 78.8% to 84.6% and escalation of care when EWS score is 5 or more improved from 70.9% to 91.7%.A step improvement in the clinical response to a deteriorating patient in the acute care ward setting at Asiri Surgical Hospital was attained by the successful quality improvement project involving the frontline care providers.

Diagnostic accuracy of the Dutch version of the 4AT for delirium detection in a mixed patient population and setting

BackgroundDelirium is an acute disturbance in attention, awareness and cognition. Immediate detection in older adults is recommended because delirium is associated with adverse outcomes. The 4 ‘A’s Test (4AT) is a short screening instrument for delirium. The aim of this study is to evaluate diagnostic accuracy of the Dutch version of the screening tool 4AT for delirium detection in different settings.MethodsProspective observational study conducted in two hospitals in patients aged ≥ 65 years in geriatric wards and the Emergency Department (ED). Each participant underwent two assessments; the index test 4AT, followed by the reference standard for delirium performed by a geriatric care specialist. The reference standard delirium is according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria.ResultsA total of 71 geriatric inpatients and 49 older ED patients were included. The prevalence of delirium was 11.6% in the acute geriatric ward and 6.1% in the ED. The sensitivity and specificity of the 4AT in the acute geriatric ward were 0.88 and 0.69, respectively. In the ED, the sensitivity and specificity were 0.67 and 0.83, respectively. The area under the receiver operating characteristic curve was 0.80 for the acute geriatric ward setting and 0.74 for the ED setting.ConclusionThe Dutch version of the 4AT is a reliable screening tool for delirium detection in both acute geriatric wards and ED. Due to its brevity and practicality (i.e., no special training is required to administer the tool), it is useful in clinical practice.

Using experience-based co-design (EBCD) to develop high-level design principles for a visual identification system for people with dementia in acute hospital ward settings

ObjectivesWe tested a modified co-design process to develop a set of high-level design principles for visual identification systems (VIS) for hospitalised people with dementia.DesignWe designed and ran remote workshops in...

Using simulation to improve confidence in the escalation of patients with learning disabilities by nurses in the acute care setting

The National Early Warning Score (NEWS) is used to collate measurements of patients’ vital functions, identifying patients who require management to prevent deterioration [1]. Not following NEWS escalation protocols is linked to adverse events and may occur due to prioritising clinical judgement over scores and communication failures [2]. Patients with learning disabilities are even more at risk of avoidable adverse events in hospital, but education to improve the understanding of the needs of these patients may be a protection against this [3]. This research assessed the improved confidence of nurses in escalation following a simulation-based course focused on escalating an unwell patient with learning difficulties. The course started with an interactive talk on how to measure NEWS by a nurse educator. A simulation-based video we created of a mismanaged scenario involving a patient with learning disabilities was shown, followed by a discussion about handover using the SBAR structure. The simulation required the attendee accurately calculating a NEWS score of an actor connected to a monitor we could control and escalate to a doctor over the phone. This simulation was shown in real time to the other attendees, and the debriefing was facilitated by a doctor trained in debriefing. Pre- and post-course questionnaires were completed by attendees to assess their nursing experience, confidence in assessing NEWS, and escalation rated on a scale of 0 (very unconfident) to 5 (very confident). The course was run 6 times for a total of 26 nurses. The median length of nursing experience was 17 months (range 1–249months). More attendees were confident (defined as 4 or 5 out of 5 in the confidence scale) in assessing NEWS, escalating to the medical team, and using SBAR post-course (96%, 96%, and 93% respectively) compared to pre-course (68%, 57%, and 54% respectively), which can be seen in Confidence of the participating nurses before and after the course. This simulation-based course focusing on care of a patient with learning disabilities has improved confidence in assessing NEWS and escalation with a structured handover to the medical team. Further research should be focused on multidisciplinary simulation on escalation in the acute care setting, and how including cases involving learning disabilities improves outcomes in this at-risk group. 1. Royal College of Physicians. National Early Warning Score (NEWS) 2 Standardising the assessment of acute-illness severity in the NHS. Updated report of a working party. London: 2017. 2. Ede J, Jeffs E, Vollam S, Watkinson P. A qualitative exploration of escalation of care in the acute ward setting. Nursing in Critical Care. 2020;25:171–178. 3. Louch G, Albutt A, Harlow-Trigg J, Moore S, Smyth K, Ramsey L, O’Hara JK. Exploring patient safety outcomes for people with learning disabilities in acute hospital settings: a scoping review. BMJ Open 2021;11:47102.

Physical Rehabilitation Before and After Lung Transplantation for COVID-19 ARDS: A Case Report.

To describe the functional trajectory and physical rehabilitation of an individual who underwent lung transplantation for COVID-19 acute respiratory distress syndrome (ARDS). A previously healthy 60-year-old man admitted to critical care pre-transplantation and followed six months post-transplant. Physical rehabilitation in the critical care, acute ward and in-patient rehabilitation settings. Despite a successful surgery, a long and complex acute care admission contributed to a slow and variable functional recovery. Significant functional limitations and physical frailty were present in the early post-transplant period. Little is known of the effects of COVID-19 superimposed upon lung transplantation on muscle function, exercise capacity, and physical activity. Future research should include case series to further understand the functional deficits and trajectory of recovery in this emerging clinical population. Standard core outcome measures should be identified for this population to enable synthesis of findings and inform short- and long-term rehabilitation strategies.

Utility of Palliative Prognostic Index in Predicting Survival Outcomes in Patients With Hematological Malignancies in the Acute Ward Setting.

The palliative prognostic index (PPI) predicts the life expectancy of patients with terminally ill cancer in hospice settings. This study aimed to evaluate PPI as a prognostic tool for predicting the life expectancy of patients with hematological malignancies admitted to the acute ward. A total of 308 patients with hematological malignancies admitted to the hematological ward at a medical center between January 2016 and December 2017 were consecutively enrolled. PPI was scored within 24 h of admission. All patients were categorized into 3 groups by PPI for comparing survival and in-hospital mortality rates. The median survival times were 38.4, 3.6, and 1.1 months for patients with good, intermediate, and poor prognostic group, respectively. The hazard ratio was 2.31 (95% CI 1.59-3.35, p < 0.001) when comparing the intermediate and good prognosis groups, and 3.90 (95% CI 2.52-6.03, p < 0.001) when comparing the poor and good prognosis groups. Forty-five (14.6%) patients died at discharge; in-hospital mortality rates among the good, intermediate, and poor prognostic groups were 9.0%, 23.4%, and 46.4%, respectively. The adjusted odds ratio for in-hospital mortality was 1.96 (95% CI, 0.80-4.82, p = 0.14) and 5.25 (95% CI, 2.01-13.7, p < 0.001) for patients in the intermediate and poor prognostic groups compared to those in the good prognostic group. PPI is an accurate prognostic tool for predicting survival times and in-hospital mortality rates in patients with hematological malignancies in an acute ward setting. PPI could assist clinicians in discussing end-of-life issues and in referring patients with hematological malignancies to palliative care.

To assess implementation of trust policy (smoke free policy) on an acute mixed mental health ward setting

AimsTo assess implementation of Trust Policy (Smoke Free Policy) on the acute adult mental health unit To evaluate barriers to implementation of local standards and NICE guidelines To evaluate if Q-Risk score is being calculated and noted.BackgroundThere are about 34,000 people residents in mental health facilities in England and Wales on any one day (Commission for Healthcare Audit and Inspection 2005) and many of them smoke.Smoke free policy implemented in the GMMH since 1st of July 2018.Smoking is single largest preventable cause of ill health &amp; premature mortality in England.Smoking prevalence is significantly higher among people admitted to hospital due to the mental illness i.e. 70%According to WHO SHS (second hand smoking), is a human carcinogen to which there is no safe level.MethodAn audit tool questionnaire was used to collect the data on the Acute Mixed mental health ward setting i.e. Bronte Ward, Laureate House, Wythenshawe HospitalIdentified method: interview with each patient, PARIS documentation review and Patient's Kardex review.Sample size: 23 and on re-audit 12.Method of data input: Microsoft ExcelData were analyzed by calculating percentageResultThe majority of the patients that took part in the Audit were smokers (91%), a high percentage overall. This indicate how important it is for a plan to be in place regarding smoking on the ward since there is a smoke free policy now in the GMMH. Our results showed that not everyone was asked regarding their smoking status (87%).An important figure that came out from the results was that only 50% of the patients asked about their smoking status were told that there is a smoke free policy.For a smoke free policy ward only 33% of the smokers that took part in the audit were provided with brief advice regarding smoking cessation which shows that there might be a need of a more precise implementation regarding support to receive brief intervention for smoking cessation, NRT and specialist advice.The results also showed that the QRisk is not calculated, a useful marker of cardiovascular risk.ConclusionGive leaflets regarding smoking cessation on admission, offer support and advice to all the patients being on the ward. And re-audit in due course to see the effect of this intervention.

Implementation of Wearable Sensors and Digital Alerting Systems in Secondary Care: Protocol for a Real-World Prospective Study Evaluating Clinical Outcomes.

BackgroundAdvancements in wearable sensors have caused a resurgence in their use, particularly because their miniaturization offers ambulatory advantages while performing continuous vital sign monitoring. Digital alerts can be generated following early recognition of clinical deterioration through breaches of set parameter thresholds, permitting earlier intervention. However, a systematic real-world evaluation of these alerting systems has yet to be conducted, and their efficacy remains unknown.ObjectiveThe aim of this study is to implement wearable sensors and digital alerting systems in acute general wards to evaluate the resultant clinical outcomes.MethodsParticipants on acute general wards will be screened and recruited into a trial with a pre-post implementation design. In the preimplementation phase, the SensiumVitals monitoring system, which continuously measures temperature, heart, and respiratory rates, will be used for monitoring alongside usual care. In the postimplementation phase, alerts will be generated from the SensiumVitals system when pre-established thresholds for vital parameters have been crossed, requiring acknowledgement from health care staff; subsequent clinical outcomes will be analyzed.ResultsEnrolment is currently underway, having started in September 2017, and is anticipated to end shortly. Data analysis is expected to be completed in 2021.ConclusionsThis study will offer insight into the implementation of digital health technologies within a health care trust and aims to describe the effectiveness of wearable sensors for ambulatory continuous monitoring and digital alerts on clinical outcomes in acute general ward settings.Trial RegistrationClinicalTrials.gov NCT04638738; https://clinicaltrials.gov/ct2/show/NCT04638738.International Registered Report Identifier (IRRID)DERR1-10.2196/26240

Hospital staff, volunteers’ and patients’ perceptions of barriers and facilitators to communication following stroke in an acute and a rehabilitation private hospital ward: a qualitative description study

ObjectivesTo explore barriers and facilitators to patient communication in an acute and rehabilitation ward setting from the perspectives of hospital staff, volunteers and patients following stroke.DesignA qualitative descriptive study as...

The impact of web-based and face-to-face simulation education programs on nurses' response to patient deterioration: A multi-site interrupted time series study

BackgroundNurses' response to patient deterioration in acute hospital wards is a priority issue. Simulation education programs improve nurses' knowledge and confidence, but the translation into better care is largely unknown for both web based (WB) and face to face (F2F) simulation programs. AimTo measure the impact of simulation education on nurses' response to patient deterioration in acute medical ward settings, and to compare the impact of WB and F2F versions. DesignAn interrupted time series, non-randomised trial across four medical wards in Victoria, Australia. Wards were allocated to either web-based or face-to-face versions of the same simulation program, FIRST2ACT. Interrupted time series measurement for six fortnights both before and after the intervention were used to measure and compare responses to deterioration. Responses to patient deterioration were extracted from medical records and grouped into outcomes for escalation (e.g. initiation of clinical review), assessment and observation (e.g. increased recording of vital signs, conscious state and pain scores) and clinical interventions (e.g. oxygen administration). Results126 nurses (89%) participated across the four wards. 946 patient records (506 in the F2F; 440 in the WB group) were included in analyses.There were significant and sustained improvements between pre and post samples in outcomes for escalation (13.0% to 28.8%; p = 0.000) and assessment and observation (conscious state recorded increased from 91.1% to 100%; p = 0.000, and pain score recorded increased from 97.8% to 99.8%; p = 0.000).There were no differences between the web-based and face-to-face groups except in appropriate oxygen application which increased by 7.7% in the F2F group and decreased by 11.8% in the WB group (p = 0.046). ConclusionsThere was a significant improvement in nurses' response to patient deterioration following both versions of simulation, indicating that both have a role to play in supporting nurses' response to patient deterioration.

Patterns of behaviour in nursing staff actioning the afferent limb of the rapid response system (RRS): A focused ethnography.

To improve understanding of afferent limb behaviour in acute hospital ward settings, to define and specify who needs to do what differently and to report what afferent limb behaviours should be targeted in a subsequent multi-phase, theory-based, intervention development process. Focused ethnography was used including direct observation of nursing staff enacting afferent limb behaviours and review of vital signs charts. An observation guide focused observation on "key moments" of the afferent limb. Descriptions of observations from between 7 January 2019-18 December 2019 were recorded in a field journal alongside reflexive notes. Vital signs and early warning scores from charts were reviewed and recorded. Field notes were analysed using structured content analysis. Observed behaviour was compared with expected (policy-specified) behaviour. Observation was conducted for 300hr. Four hundred and ninety-nine items of data (e.g., an episode of observation or a set of vital signs) were collected. Two hundred and eighty-nine (58%) items of data were associated with expected (i.e. policy-specified) afferent limb behaviour; 210 (42%) items of data were associated with unexpected afferent limb behaviour (i.e. alternative behaviour or no behaviour). Ten specific behaviours were identified where the behaviour observed deviated (negatively) from policy or where no action was taken when it should have been. One further behaviour was seen to expedite the assessment of a deteriorating patient by an appropriate responder and was therefore considered a positive deviance. Afferent limb failure has been described as a problem of inconsistent staff behaviour. Eleven potential target behaviours for change are reported and specified using a published framework. Clear specification of target behaviour will allow further enquiry into the determinants of these behaviours and the development of a theory-based intervention that is more likely to result in behaviour change and can be tested empirically in future research.

Interventions to improve inpatients' sleep quality in intensive care units and acute wards: a literature review.

Sleep is essential for the physical and psychological restoration of inpatients, and lack of sleep results in sleep deprivation and poor sleep quality, with potentially harmful consequences. To summarise sleep-promoting interventions in the Intensive care unit (ICU) and acute ward setting. Six databases were searched to obtain studies for review and eight studies were selected, appraised, analysed and produced two themes: sleep-disturbing factors and sleep-promoting strategies. Sleep-disturbing factors included environmental factors (such as light and noise), illness-related factors (such as pain, anxiety and discomfort), clinical care and diagnostics. Sleep-promoting strategies included using pharmacological aids (medication) and non-pharmacological aids (reducing noise and disturbances, eye masks, earplugs and educational and behavioural changes). The literature review showed that both ICU and acute ward settings affect patients' sleep and both use similar strategies to improve this. Nevertheless, noise and sleep disturbances remain the most critical sleep-inhibiting factors in both settings. The review recommended future research should focus on behavioural changes among health professionals to reduce noise and improve patients' sleep.

Oral Care for Neuroscience patients in New Zealand – A national survey

Abstract Aims: To understand the experience and knowledge of neuroscience nurses working in acute ward settings in New Zealand regarding oral care. To determine what educational requirements were needed to standardise oral care. Data sources: A systematic review of articles was conducted using Cinahl, PubMed, Cochrane and Google scholar between 2007-2019. Methods: An online survey using Survey Monkey with three out of five units participating from the north and South Island of New Zealand using qualitative and quantitative data. Results: 34% of nurses completed the survey from three different neuroscience wards. Oral hygiene education was provided to the majority of respondents during their initial nursing training, however this was considered inadequate and most nurses did not receive oral hygiene education since their training. It was considered that there was a lack of oral care assessment tools and guidelines available in New Zealand. A lack of evidence-based practice existed. Therefore, inconsistencies over products and frequency of care was problematic. Barriers to effective oral care included the uncooperative patient, lack of access to the mouth and a perceived lack of time to provide oral care. Conclusion: The experience and knowledge of neuroscience nurses in this study was varied. An opportunity existed to implement an oral assessment tool and guideline which could improve the oral care of the neuroscience patient and standardize care throughout New Zealand. Oral hygiene education should be provided and available for nursing students, registered nurses, health care assistants, patients and family to ensure consistent effective oral care. Impact: As a result of this study, a guideline and assessment flowchart were created with an online e-learning experience. This was distributed to a number of hospitals nationwide to ensure standardization of care across all neuroscience wards.

A qualitative exploration of escalation of care in the acute ward setting.

Background“Failure to Rescue” includes failing to prevent avoidable patient deterioration and death. Despite its use, delays in care escalation still affect patient outcomes.Aims and ObjectiveThe aim of this qualitative service evaluation was to map the barriers and facilitators to the escalation of care in the acute ward setting and identify those that are modifiable.DesignA total of 55 hours of qualitative observations were completed to capture care escalation events. These were conducted at two hospital sites in one National Health Service trust.MethodsObservations were iterative, with research team meetings being used to discuss the data and future methods. Field notes were analysed thematically by two researchers, extracting data on barriers and facilitators to escalation of care.ResultsClinical nursing staff challenged the sensitivity and specificity of Early Warning Scores, describing tool failings in certain clinical scenarios. Staff did not escalate based on the alerting Early Warning Scores alone but used other clinical factors, such as bleeding, which are not necessarily captured in the scoring systems. Staff frequently did not re‐escalate low‐level scores. Patient and non‐patient factors identified as posing barriers to escalation were complex care needs, patient outlier status, and involvement of multiple care teams. Factors negatively affecting the chain of communication during escalation were team tension, staffing levels, and inadequate handover.ConclusionThis service evaluation identified barriers and facilitators to the escalation of care in the acute ward setting. Unlike other studies, we found that re‐escalation or tracking of deterioration was problematic. Patients identified as being at a higher risk of escalation failure included complex patients, outliers, and patients with multiple care teams.Relevance to clinical practiceThis service evaluation demonstrates continuing health care communication barriers. Patient groups (complex patients and outliers) risk process failures during escalation. This can be applied in clinical practice by staff anticipating problems in these patients, documenting clear escalation pathways.

Towards development of alert thresholds for clinical deterioration using continuous predictive analytics monitoring.

Patients who deteriorate while on the acute care ward and are emergently transferred to the Intensive Care Unit (ICU) experience high rates of mortality. To date, risk scores for clinical deterioration applied to the acute care wards rely on static or intermittent inputs of vital sign and assessment parameters. We propose the use of continuous predictive analytics monitoring, or data that relies on real-time physiologic monitoring data captured from ECG, documented vital signs, laboratory results, and other clinical assessments to predict clinical deterioration. A necessary step in translation to practice is understanding how an alert threshold would perform if applied to a continuous predictive analytic that was trained to detect clinical deterioration. The purpose of this study was to evaluate the positive predictive value of 'risk spikes', or large abrupt increases in the output of a statistical model of risk predicting clinical deterioration. We studied 8111 consecutive patient admissions to a cardiovascular medicine and surgery ward with continuous ECG data. We first trained a multivariable logistic regression model for emergent ICU transfer in a test set and tested the characteristics of the model in a validation set of 4059 patient admissions. Then, in a nested analysis we identified large, abrupt spikes in risk (increase by three units over the prior 6h; a unit is the fold-increase in risk of ICU transfer in the next 24h) and reviewed hospital records of 91 patients for clinical events such as emergent ICU transfer. We compared results to 59 control patients at times when they were matched for baseline risk including the National Warning Score (NEWS). There was a 3.4-fold higher event rate for patients with risk spikes (positive predictive value 24% compared to 7%, p = 0.006). If we were to use risk spikes as an alert, they would fire about once per day on a 73-bed acute care ward. Risk spikes that were primarily driven by respiratory changes (ECG-derived respiration (EDR) or charted respiratory rate) had highest PPV (30-35%) while risk spikes driven by heart rate had the lowest (7%). Alert thresholds derived from continuous predictive analytics monitoring are able to be operationalized as a degree of change from the person's own baseline rather than arbitrary threshold cut-points, which can likely better account for the individual's own inherent acuity levels. Point of care clinicians in the acute care ward settings need tailored alert strategies that promote a balance in recognition of clinical deterioration and assessment of the utility of the alert approach.

A new atrial fibrillation protocol and rationale for acute care

The prevalence of atrial fibrillation (AF) continues to rise in the UK and this article provides clinicians with an evidence-based protocol for use in an acute ward setting for patients who are diagnosed with acute AF. The protocol has been based on the National Institute for Health Care Excellence (NICE) guidelines to ensure that it can be used in trusts across the UK. There is guidance for most members of the multidisciplinary team to follow to ensure they are providing evidence-based care within their own settings. Although this protocol is more focused on acute care settings, it can also be used by clinicians in primary care settings, as they can implement certain guidelines to suit their care settings. As well as pharmacological management, there are also some non-pharmacological management interventions that can be used by nurses and other clinicians to help their patients manage their condition more effectively.

Abstract P-336: MEASURING CHILDREN’S QUALITY OF LIFE IN AN ACUTE HOSPITAL CARDIAC WARD SETTING: A THINK ALOUD STUDY COMPARING THE CHU9D AND PEDSQL QUESTIONNAIRES

Aims & Objectives: RAPID is a feasibility study of an innovative wireless early warning system to detect and allow early response to clinical deterioration. Looking ahead to future economic evaluation of RAPID, this study aimed to explore the feasibility of collecting data on children’s health-related quality of life in this acute hospital setting, using the CHU9D and PedsQL questionnaires, as reported by patients’ parents. Methods Twenty-two parents of children aged 3–6 years admitted to the Birmingham Children’s Hospital cardiac wards took part in a ‘think aloud’ exercise, that involved verbalising their thoughts while completing the age-specific CHU9D and PedsQL paediatric quality of life questionnaires, and participating in a semi-structured interview. Results The majority of parents were able to comprehend and respond to most of the questions in line with expectations, but a range of completion errors were identified. Themes identified include: (1) difficulty in relating responses to the questionnaires’ required time periods, (2) perceptions of the irrelevance of particular questions in the hospital setting, (3) lack of confidence in distinguishing appropriate responses, (4) a shorter questionnaire is not necessarily easier for parents to answer, and (5) the perceived importance of the potential for future quality of life in addition to current experience. Conclusions The ‘think aloud’ approach provides valuable insight into how respondents make choices when completing questionnaires. There are pros and cons associated with attempting to use either the CHU9D or PedsQL questionnaires to collect parent-reported quality of life data for young children in an acute cardiac ward setting.

Examining barriers to healthcare providers’ adoption of a hospital-wide electronic patient journey board

BackgroundThe dynamic environment that characterizes patient care in hospitals requires extensive communication between staff. Electronic status board applications are used to improve the flow of communication in hospitals. To date there has been limited work exploring the adoption of these applications in general acute ward settings. AimThis study aimed to identify barriers to the adoption of an electronic patient journey board (EPJB)11Electronic Patient Journey Board (EPJB). application in acute wards of a hospital. MethodData were collected at a large public teaching hospital in Sydney, Australia. The EPJB was implemented across all hospital wards with the aim of improving multidisciplinary communication in wards. Observations (29.5 h) and contextual interviews (n = 33) with hospital staff were conducted in two acute wards of the hospital. ResultsTwo manual whiteboards were used on wards, in addition to the EPJB, to compensate for information not being available or accessible on the EPJB. Despite the stated purpose of the EPJB, the tool did not appear to support team communication on wards. Barriers to adoption and optimal use of the EPJB included inappropriate location and configuration of the system, limitations in information timeliness, quality and lack of customisation (for different user groups), inconsistent information updates and the absence of a shared understanding of the purpose of the EPJB among the various user groups. ConclusionMultiple socio-technical barriers influenced uptake and optimal use of the EPJB by healthcare providers. Engaging users early in the design and implementation of electronic status board applications is required to ensure effective use of these complex interventions on general wards.