Communication Of Deterioration Research Articles

Junior Doctor Communication Systems and the Deterioration Communication Management Theory.

Inadequate communication is a factor in suboptimal junior doctor management of deteriorating ward patients. Junior doctors' information and communication technology (ICT) systems are not the sole cause or cure for this. However, junior doctors are already dissatisfied with existing technologies for general hospital communication. The Deterioration Communication Management Theory (DCMT) provides a means to approach these issues by uniting two themes: 1) factors affecting the properties of ICT used to communicate to junior doctors; and 2) factors affecting junior doctor interpretation of communication about deteriorating hospital patients. ICT factors include how the combination of physical devices and mode of usage affect user perception of system reliability and efficiency. Junior doctors interpret clinician communication about patient deterioration in terms of risk, which is affected by their contextual responsibility and experience. Perceived risk and contextual experience in turn affects their communication efficiency. Combining these themes gives more options to explain junior doctor communication in this clinical context and to design ICT systems to improve it.

Early warning scores in cardiac arrest patients

Background: Significant physiological deterioration in the 8 hours pre arrest is evident in 84% of in-hospital cardiac arrests. The modified early warning score (MEWS) is an example of a physiological ‘track and trigger’ system designed to identify patients at risk of clinical deterioration. Aims: The primary aim of this study was to describe the use and characteristics of the MEWS score in the 24-hour period preceding cardiac arrest to establish any pattern and its relationship to the subsequent deterioration of patients. Methods: A retrospective case note review was conducted of all cardiac arrests in the study hospital occurring over a 6-month period. Results: The majority of cardiac arrests occurred out of hours (69.7%). Of the nurses recording the final MEWS preceding cardiac arrest, 13 (39.9%) were registered nurses and 20 (60.6%) were healthcare assistants. The majority of MEWS recorded immediately preceding cardiac arrest were 1 (15; 45%); the mean MEWS was 2.24, the median was 2 and the mode was 1. Conclusion: This retrospective case note review has examined the use and characteristics of the MEWS on the medical wards of one district general hospital in the 24 hours preceding cardiac arrest. Key issues have been identified regarding MEWS at the point of cardiac arrest, and the use of the referral pathway by healthcare professionals. Communication of deterioration is imperative to the management of deterioration on the general wards.

Track, trigger and teamwork: Communication of deterioration in acute medical and surgical wards

The majority of hospitals in the United Kingdom (UK) use some form of track and trigger scoring system, such as early warning scores, to identify deteriorating patients; however, response by the multi-professional team is not always timely and problems with recognition of deterioration persist. To examine ward nurse and critical care outreach staff perceptions of the management of patients who deteriorate in acute wards. A qualitative design was used with critical incident (CI) technique employed to structure data collection. Semi-structured interviews were undertaken with nurses who had managed a patient who was referred to the outreach team (n=11) and members of the outreach team (n=3). Registered nurses in this study looked at trends when assessing their patients visually. However, early warning scoring was not a key component of patient assessment and was used more commonly to quantify deterioration once the patient's changing condition had been recognised. Findings demonstrated some tensions in team communication. The results of this study suggest that clinicians need a better understanding of the value of track and trigger scoring systems in identifying trends in the patient's condition. Further, our data suggest that steps need to be taken in acute hospital wards to improve team members' understanding of each others' roles and capabilities.

Recognition and communication of patient deterioration in a regional hospital: A multi-methods study

In this study we aimed to identify the cues that ward nurses and doctors use to identify patient deterioration and, secondly, examine the assessment and communication of deterioration in patients on acute wards of a regional hospital. Mixed methods case study design in a 220 bed regional hospital. Case studies originated from patients admitted unexpectedly to ICU from general wards (n=17). Data collection occurred within 72 h of the patient's admission to ICU. Interviews with 11 nurses and 14 doctors, and chart audit of 17 patient records for the 24 h prior to ICU were undertaken. The results demonstrate reliance on vital signs for nurses and doctors for initial identification of patient deterioration. Subsequent to this, nurses relied on assessment of the patient's physical capabilities whilst doctors undertook additional clinical investigations. Admission category and co-morbidities increased clinicians' identification of deterioration but the extent of assessment was dictated by 'usual practice' for the regional hospital, the ward or particular patient category. A lack of timely referral to more senior clinicians was identified. Chart audit found that 13 (76%) patients had clinical markers prior to ICU admission and 10 (56%) had these markers for >2h in the previous 24h. This study highlights inadequate communication between clinicians and lack of process for ensuring timely management when patients deteriorate in a regional hospital. The use of casual or locum staff who are less familiar with the clinical culture of regional hospitals may influence the recognition of, and response to, deteriorating ward patients.