085 Enabling effective escalation of clinical concerns: a simulation-based study day to enhance the skills of health care support workers. (December 2018)

• Record Type: Journal Article
• Authors: Broughton, E; Boyd, H; Manget, J
• Is Part Of: Archives of disease in childhood. Volume 103:Supplement 2(2018)
• Page Start: A34
• Page End: A35
• Publication Date: 2018-12
• Subjects: Infants -- Diseases -- Periodicals; Newborn infants -- Diseases -- Periodicals; Fetus -- Diseases -- Periodicals; 618.920105
• DOI: 10.1136/goshabs.85
• Languages: English
• ISSNs: 1359-2998

Abstract

Abstract : Background: Across the UK Healthcare Support Workers (HCSWs) makeup 40% of the healthcare workforce, provide 60% of patient care and receive less than 5% of the training budget. The expectation of this workforce is that they will deliver high-quality care that is compassionate and clinically sound. Hierarchy is a recognised barrier to the escalation of deterioration; combined with critically ill patients, a challenging context is created in which to escalate concerns. Methods: A one-day blended programme was developed for HCSWs to provide an overview of clinical systems and escalation: focussing on 'taking obs' and effective escalation of concerns. The clinical assessment process was broken down and taught through didactic sessions, following the A (airway) to E (exposure) assessment structure. Escalation was explored in a workshop lead by a middle-grade medical trainee. Candidates participated in simulated scenarios as the first responder. Each candidate was required to undertake a full A to E assessment, accurately identify abnormalities and escalate concerns to a senior nurse and middle-grade doctor. Results: Qualitative data was collected via a formal candidate survey. The day rated 5/5 for usefulness, however, through comparative analysis of candidate performance against intended learning outcomes, we have identified that escalation across the hierarchy gradient was not the greatest challenge for HCSWs. The difficulty in application of a structured approach to assessment was the prominent barrier to recognition and consequently prompt escalation. Conclusion: The course demonstrated that fundamental principles behind patient observation to be understood and applied in a structured manner before challenges in escalation can be addressed. Moving forward, we will provide more time for candidates to practice structured assessment on a manikin prior to applying this within simulated patient scenarios. Only once this is achieved, can we expect to address escalation over the hierarchy gradient.