Understanding the pre-medical emergency team tier of a mature rapid response system: A content analysis of guidance documents. Issue 5 (September 2021)

• Record Type: Journal Article
• Authors: Sprogis, Stephanie K.; Currey, Judy; Jones, Daryl; Considine, Julie
• Is Part Of: Australian critical care. Volume 34:Issue 5(2021)
• Page Start: 427
• Page End: 434
• Publication Date: 2021-09
• Subjects: Clinical deterioration -- Early medical intervention -- Health policy -- Hospital rapid response team -- Nursing -- Patient care team -- Patient safety -- Qualitative research -- Systems analysis; Intensive care nursing -- Periodicals; Intensive care nursing -- Australia -- Periodicals; Electronic journals; 616.028
• DOI: 10.1016/j.aucc.2020.12.002
• Languages: English
• ISSNs: 1036-7314

Abstract

Abstract: Background: The pre-medical emergency team (pre-MET) tier of rapid response systems (RRSs) includes extended activation criteria to identify earlier clinical deterioration and a ward-based patient review that is undertaken by the affected patient's admitting team or covering doctors. There is limited understanding of the structure and processes of the pre-MET RRS tier that are expected to guide clinicians' actions and subsequent patient safety outcomes. Objective: The aim of the study was to describe the structure and processes of the pre-MET RRS tier in one acute care setting. Methods: An exploratory descriptive design involving document analysis was used. Guidance documents (policies, procedures, guidelines, charts, educational materials) were obtained from one health service with a mature, multitiered RRS in Melbourne, Australia. Documents were analysed using content analysis. Concept- and data-driven approaches were used to construct a coding frame. Results: Nineteen guidance documents supporting the pre-MET RRS tier on general wards were analysed. The coding frame consisted of seven main categories: Defining the Pre-MET RRS Tier, Essential Resources for Operationalisation, Recognising Pre-MET Events, Pathways for Activation, Exceptions to the Rule, Clinician Responses to Pre-MET Events, and Recording Pre-MET Events. The structures and processes of the pre-MET RRS tier were largely consistent with national guidelines, but there were internal inconsistencies in pre-MET activation criteria and unclear recommendations for modifying criteria. Pathways for activating the pre-MET RRS tier were complex and involved many steps, including validation processes before escalation of care to doctors. Responses to pre-MET events were seldom aligned to specific clinician types or groups, with nurses and allied health clinicians being under-represented. Conclusions: We identified opportunities to improve guidance documents supporting the pre-MET RRS tier that may assist other health services engaged in planning or evaluating pre-MET strategies. Further research is needed to understand clinicians' use of the pre-MET RRS tier to inform targeted strategies to optimise its design and implementation.