Clinicians' attitudes towards escalation and management of deteriorating patients: A cross-sectional study

Deb Newman; Fran Hofstee; Karen Bowen; Deb Massey; Olivia Penman; Christina Aggar

doi:10.1016/j.aucc.2022.03.004

Clinicians' attitudes towards escalation and management of deteriorating patients: A cross-sectional study

Aust Crit Care. 2023 May;36(3):320-326. doi: 10.1016/j.aucc.2022.03.004. Epub 2022 Apr 28.

Authors

Deb Newman¹, Fran Hofstee², Karen Bowen³, Deb Massey⁴, Olivia Penman⁵, Christina Aggar⁶

Affiliations

¹ Northern New South Wales Local Health District, 89 Tamar St, Ballina, NSW, 2478, Australia. Electronic address: deborah.newman@health.nsw.gov.au.
² Northern New South Wales Local Health District, 89 Tamar St, Ballina, NSW, 2478, Australia. Electronic address: fran.hofstee@health.nsw.gov.au.
³ Northern New South Wales Local Health District, 89 Tamar St, Ballina, NSW, 2478, Australia. Electronic address: karen.bowen@health.nsw.gov.au.
⁴ Southern Cross University School of Health & Human Sciences, Southern Cross Drive, Bilinga, QLD, 4225, Australia. Electronic address: deb.massey@scu.edu.au.
⁵ Southern Cross University School of Health & Human Sciences, Southern Cross Drive, Bilinga, QLD, 4225, Australia. Electronic address: olivia.penman@scu.edu.au.
⁶ Northern New South Wales Local Health District, 89 Tamar St, Ballina, NSW, 2478, Australia; Southern Cross University School of Health & Human Sciences, Southern Cross Drive, Bilinga, QLD, 4225, Australia. Electronic address: christina.aggar@scu.edu.au.

PMID: 35490110
DOI: 10.1016/j.aucc.2022.03.004

Abstract

Background: Internationally, rapid response systems have been implemented to recognise and categorise hospital patients at risk of deterioration. Whilst rapid response systems have been implemented with a varying amount of success, there remains ongoing concern about the lack of improvement in the escalation, and management of the deteriorating patient. It also remains unclear why some clinicians fail to escalate concerns for the deteriorating patient.

Objective: The objective of this study was to explore clinicians' attitudes towards the escalation, and management of the deteriorating patient.

Methods: A cross-sectional online survey of conveniently sampled clinicians from the acute care sector in a regional health district in Australia was conducted. The Clinicians' Attitudes towards Responding and Escalating care of Deteriorating patients scale, was used to explore attitudes towards the escalation and management of the deteriorating patient.

Results: Survey responses were received from medical officers (n = 43), nurses (n = 677), allied health clinicians (n = 60), and students (n = 57). Years of experience was significantly associated with more confidence responding to deteriorating patients (p < .001) and significantly less fears about escalating care (p < .001). Nurses (M = 4.16, SD = .57) and students (M = 4.11, SD = .55) in general had significantly greater positive beliefs that the rapid response system would support them to respond to the deteriorating patient than allied health (M = 3.67, SD = .64) and medical (M = 3.87, SD = .54) clinicians, whilst nurses and medical clinicians had significantly less fear about escalating care and greater confidence in responding to deteriorating patients than allied health clinicians and healthcare students (p < .001).

Conclusion: Nurses and medical officers have less fear to escalate care and greater confidence responding to the deteriorating patient than allied health clinicians and students. Whilst the majority of participants had positive perceptions towards the rapid response system, those with less experience lacked the confidence to escalate care and respond to the deteriorating patient.

Keywords: Attitude; Deteriorating patient; Escalation of care; Rapid response systems.

MeSH terms

Attitude of Health Personnel
Australia
Clinical Deterioration*
Cross-Sectional Studies
Health Personnel
Humans