Abstract
Background
Failure to recognise and respond to clinical deterioration is a major cause of high
mortality events in emergency department (ED) patients. Whilst there is substantial
evidence that rapid response teams reduce hospital mortality, unplanned intensive
care admissions, and cardiac arrests on in-patient settings, the use of rapid response
teams in the ED is variable with poor integration of care between emergency and specialty/intensive
care teams.
Objectives
The aim of this study was to evaluate uptake and impact of a rapid response system
on recognising and responding to deteriorating patients in the ED and identify implementation
factors and strategies to optimise future implementation success.
Methods
A dual-methods design was used to evaluate an ED Clinical Emergency Response System
(EDCERS) protocol implemented at a regional Australian ED in June 2019. A documentation
audit was conducted on patients eligible for the EDCERS during the first 3 months
of implementation. Quantitative data from documentation audit were used to measure
uptake and impact of the protocol on escalation and response to patient deterioration.
Facilitators and barriers to the EDCERS uptake were identified via key stakeholder
engagement and consultation. An implementation plan was developed using the Behaviour
Change Wheel for future implementation.
Results
The EDCERS was activated in 42 (53.1%) of 79 eligible patients. The specialty care
team were more likely to respond when the EDCERS was activated than when there was
no activation ([n = 40, 50.6%] v [n = 26, 32.9%], p = 0.01). Six facilitators and
nine barriers to protocol uptake were identified. Twenty behaviour change techniques
were selected and informed the development of a theory-informed implementation plan.
Conclusion
Implementation of the EDCERS protocol resulted in high response rates from specialty
and intensive care staff. However, overall uptake of the protocol by emergency staff
was poor. This study highlights the importance of understanding facilitators and barriers
to uptake prior to implementing a new intervention.
Keywords
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Article info
Publication history
Published online: December 07, 2022
Accepted:
October 9,
2022
Received in revised form:
October 2,
2022
Received:
July 4,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
Crown Copyright © 2022 Published by Elsevier Ltd on behalf of Australian College of Critical Care Nurses Ltd. All rights reserved.
