‘Changes of concern’ for detecting potential early clinical deterioration: A validation study

Cioffi, Jane; Conway, Richard; Everist, Leanne; Scott, Janet; Senior, John

doi:10.1016/j.aucc.2010.04.002

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Volume 23, Issue 4 , Pages 188-196, November 2010

‘Changes of concern’ for detecting potential early clinical deterioration: A validation study

Jane Cioffi, PhD
- School of Nursing and Midwifery, University of Western Sydney, Locked Bag 1797, Penrith South DC, NSW 1797, Australia
- Corresponding author. Tel.: +61 2 96859115; fax: +61 2 96859023.
Richard Conway, MA
- Sydney West Area Health Service, PO Box 533, Wentworthville, NSW 2145, Australia
- Tel.: +61 2 98455555; fax: +61 2 98455000.
Leanne Everist
- Sydney West Area Health Service, Blacktown Road, Blacktown, NSW 2148, Australia
- Tel.: +61 2 98811800; fax: +61 2 9881 1586.
Janet Scott, BHSc
- Sydney West Area Health Service, PO Box 63, Penrith, NSW 2751, Australia
- Tel.: +61 2 47342147; fax: +61 2 47343134.
John Senior, BAppSc (Nursing)
- NSW College of Nursing, Australia
- Sydney West Area Health Service, Norval St., Auburn, NSW 2144, Australia
- Tel.: +61 2 87593608; fax: +61 2 87593123.

Received 26 May 2009; received in revised form 16 March 2010; accepted 30 April 2010. published online 31 May 2010.

Summary

Background

The criteria used for calling emergency response teams to patients at-risk of clinical deterioration in the acute care adult hospital population include the criterion ‘patient of concern’. When calling teams to patients of concern, some ‘changes of concern’ used by nurses have been identified; however the validity of these ‘changes of concern’ is unknown.

Purpose

This study aimed to determine the content validity of ‘changes of concern’ used by nurses to call emergency response teams.

Methods

Ten nurses who had 5 years or more experience with emergency response teams formed an expert group. This expert group examined content validity of the ‘changes of concern’ nurses used for calling emergency response teams using criterion, ‘patient of concern’ with a questionnaire based on Bausell's content validity criteria of necessity and sufficiency. Data were summarized using descriptive statistics.

Findings

The main findings indicate that the 10 ‘changes of concern’ are agreed to be necessary to possibly identify early deterioration in adult patients that may require a call using criterion, ‘patient of concern’. The associated factors that relate to these ‘changes of concern’ are also confirmed to be necessary to assess when these changes are present in patients.

Conclusion

Assessment underpinned by these changes of concern (indicators) can provide more complete clinical information for clinicians to recognise possible early deterioration of patients and to coach others so building capacity to appropriately call emergency response teams resulting in increased patient safety. Research is indicated that further explores and identifies the use of ‘patient of concern’ criterion and that examines the effectiveness of clinical information being used to detect potential early clinical deterioration.

Keywords: Emergency response teams, Content validation, Patient of concern, Criteria