Differences in identification of patients' deterioration may hamper the success of clinical escalation protocols.
Adult
Aged
Aged, 80 and over
Attitude of Health Personnel
Clinical Decision-Making
Clinical Deterioration
Critical Care
/ statistics & numerical data
Critical Illness
/ therapy
Denmark
Female
Humans
Internet
Male
Middle Aged
Netherlands
Prospective Studies
Risk Assessment
Severity of Illness Index
Surveys and Questionnaires
United Kingdom
Journal
QJM : monthly journal of the Association of Physicians
ISSN: 1460-2393
Titre abrégé: QJM
Pays: England
ID NLM: 9438285
Informations de publication
Date de publication:
01 Jul 2019
01 Jul 2019
Historique:
received:
23
11
2018
revised:
22
02
2019
pubmed:
5
3
2019
medline:
21
12
2019
entrez:
5
3
2019
Statut:
ppublish
Résumé
Timely and consistent recognition of a 'clinical crisis', a life threatening condition that demands immediate intervention, is essential to reduce 'failure to rescue' rates in general wards. To determine how different clinical caregivers define a 'clinical crisis' and how they respond to it. An international survey. Clinicians working on general wards, intensive care units or emergency departments in the Netherlands, the United Kingdom and Denmark were asked to review ten scenarios based on common real-life cases. Then they were asked to grade the urgency and severity of the scenario, their degree of concern, their estimate for the risk for death and indicate their preferred action for escalation. The primary outcome was the scenarios with a National Early Warning Score (NEWS) ≥7 considered to be a 'clinical crisis'. Secondary outcomes included how often a rapid response system (RRS) was activated, and if this was influenced by the participant's professional role or experience. The data from all participants in all three countries was pooled for analysis. A total of 150 clinicians participated in the survey. The highest percentage of clinicians that considered one of the three scenarios with a NEWS ≥7 as a 'clinical crisis' was 52%, while a RRS was activated by <50% of participants. Professional roles and job experience only had a minor influence on the recognition of a 'clinical crisis' and how it should be responded to. This international survey indicates that clinicians differ on what they consider to be a 'clinical crisis' and on how it should be managed. Even in cases with a markedly abnormal physiology (i.e. NEWS ≥7) many clinicians do not consider immediate activation of a RRS is required.
Sections du résumé
BACKGROUND
BACKGROUND
Timely and consistent recognition of a 'clinical crisis', a life threatening condition that demands immediate intervention, is essential to reduce 'failure to rescue' rates in general wards.
AIM
OBJECTIVE
To determine how different clinical caregivers define a 'clinical crisis' and how they respond to it.
DESIGN
METHODS
An international survey.
METHODS
METHODS
Clinicians working on general wards, intensive care units or emergency departments in the Netherlands, the United Kingdom and Denmark were asked to review ten scenarios based on common real-life cases. Then they were asked to grade the urgency and severity of the scenario, their degree of concern, their estimate for the risk for death and indicate their preferred action for escalation. The primary outcome was the scenarios with a National Early Warning Score (NEWS) ≥7 considered to be a 'clinical crisis'. Secondary outcomes included how often a rapid response system (RRS) was activated, and if this was influenced by the participant's professional role or experience. The data from all participants in all three countries was pooled for analysis.
RESULTS
RESULTS
A total of 150 clinicians participated in the survey. The highest percentage of clinicians that considered one of the three scenarios with a NEWS ≥7 as a 'clinical crisis' was 52%, while a RRS was activated by <50% of participants. Professional roles and job experience only had a minor influence on the recognition of a 'clinical crisis' and how it should be responded to.
CONCLUSION
CONCLUSIONS
This international survey indicates that clinicians differ on what they consider to be a 'clinical crisis' and on how it should be managed. Even in cases with a markedly abnormal physiology (i.e. NEWS ≥7) many clinicians do not consider immediate activation of a RRS is required.
Identifiants
pubmed: 30828732
pii: 5369095
doi: 10.1093/qjmed/hcz052
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
497-504Investigateurs
Paul Barach
(P)
Helene Beaugrand
(H)
Dorothy Breen
(D)
Declan Byrne
(D)
Catriona Chalmers
(C)
Hayley Cleaver
(H)
Eilish Croke
(E)
Elinor Davis
(E)
Peter Donnelly
(P)
Eímhín Dunne
(E)
Lesley Durham
(L)
Bryn Ellis
(B)
Rohan Goel
(R)
Chris Hancock
(C)
Jillian Hartin
(J)
Denise Hinge
(D)
Dirk Hueske-Kraus
(D)
Sean Kennelly
(S)
Geoffrey Lighthall
(G)
Rebecca Lunn
(R)
Michael Müller
(M)
Clodagh O'Dwyer
(C)
Kerian O'Mahony
(K)
Informations de copyright
© The Author(s) 2019. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For permissions, please email: journals.permissions@oup.com.