Patients’ and families’ perception of a need for a patient and/or family initiated rapid response service: a case study design

Recent research focuses on patient and/or family activating a rapid response service (RRS) to further improve early recognition and response to the deteriorating patient. However limited literature describes how ward patients and their families perceive physiological deterioration and barriers to activating these calls. This study explored patients’ and families’ experiences of acute deterioration in the ward, their perception of a need for a patient and/or family activated RRS and barriers preventing them from using it. The study was approved by the hospital research office. Using a case study research design, we used face to face semi-structured interviews, field notes and reflective journaling, to collect data. Between December 2015 and February 2016, purposeful sampling recruited 41 ward participants and/or family members who either experienced medical emergency team (MET) calls (n=14), critical care outreach (CCO) review (n=14) or no recent rapid response call (n=13). All recruited patient data were analysed using double blinded coding to identify emerging patterns and themes. The median age was 63.0 years (range=21.0-88.0) and most participants were male (n=33, 63.6%). The mean length of hospital stay was 5.8 days (range=1.0-18.0). Six themes emerged and included: 1) patients having knowledge of their illness and deterioration with 1/3 of MET and CCO patients fearful they were going to die, 2) patient and family unaware ward staff had recognised their deterioration, 3) relief and reassurance on arrival of the CCO and MET teams, 4) the importance of recovering and returning to their normal lives, 5) support for a patient and family activated RRS and 6) cultural, spiritual and personal beliefs that are likely to prevent some patients from using such a service. In conclusion, most participants support a patient and family activated RRS however a number of factors need to be considered to ensure it is implemented successfully.