A realistic evaluation of early warning systems and acute care training for early recognition and management of deteriorating ward-based patients

• Main Author: McGaughey, Jennifer Margaret
• Published: Queen's University Belfast 2013
• Subjects: 616.028
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.602463

Rapid Response Systems but is dependent upon nurses utilising EWS protocols and applying Acute Life-threatening Events: Recognition and Treatment (ALERT) course best practice guidelines. To date there is limited evidence on the effectiveness of EWS or ALERT as research has primarily focused on measuring patient outcomes (cardiac arrests, lCU admissions) following the implementation of a Rapid Response Team. The aim of this study was to evaluate factors that enabled and constrained the implementation and service delivery of Early Warnings Systems (EWS) and acute care training in practice in order to provide direction for enabling their success and sustainability. The research design was an embedded multiple case study approach of four wards in two hospitals in Northern Ireland. It followed the principles of realist evaluation research which allowed empirical data to be gathered to test and refine RRS programme theory. This approach used a variety of mixed methods to test the programme theories including individual and focus group interviews, observation and documentary analysis of EWS compliance data and ALERT training records . Data synthesis found similar regularities or factors enabling or constraining successful implementation across the case study sites. Findings showed that personal (confidence; clinical judgement; professional accountability; personality). social (ward leadership; communication), organisational (workload; time pressures; staffing levels and skill-mix), educational (constraints on training and experiential learning) and cultural (delegation of observations. referral hierarchy; rigid recording practices) influences impact on EWS and acute care training outcomes. RRS theory refinement using realist evaluation explained what works, for whom in what circumstances. Future service provision needs to consider improved staffing levels; flexible implementation of protocols underpinned by empowerment and clinical judgement; on-going experiential ward-based learning and enhanced clinical leadership to enable the success and sustainability of Rapid Response Systems.