Journal Article

What stops hospital clinical staff from following protocols? An analysis of the incidence and factors behind the failure of bedside clinical staff to activate the rapid response system in a multi-campus Australian metropolitan healthcare service

Hore, Tonina, Ramsay, Wayne, Kitto, Simon, Marshall, Stuart, Finnigan, Monica, Wilson, Stuart, Shearer, Bill, Buist, Michael David, Sturgess, Tamica

2012

Overview

ObjectiveTo explore the causes of failure to activate the rapid response system (RRS). The organisation has a recognised incidence of staff failing to act when confronted with a deteriorating patient and leading to adverse outcomes.DesignA multi-method study using the following: a point prevalence survey to determine the incidence of abnormal simple bedside observations and activation of the rapid response team by clinical staff; a prospective audit of all patients experiencing a cardiac arrest, unplanned intensive care unit admission or death over an 8-week period; structured interviews of staff to explore cognitive and sociocultural barriers to activating the RRS.SettingSouthern Health is a comprehensive healthcare network with 570 adult in-patient beds across four metropolitan teaching hospitals in the south-eastern sector of Melbourne.MeasurementsFrequency of physiological instability and outcomes within the in-patient hospital population. Qualitative data from staff interviews were thematically coded.ResultsThe incidence of physiological instability in the acute adult population was 4.04%. Nearly half of these patients (42%) did not receive an appropriate clinical response from the staff, despite most (69.2%) recognising their patient met physiological criteria for activating the RRS, and being ‘quite’, or ‘very’ concerned about their patient (75.8%). Structured interviews with 91 staff members identified predominantly sociocultural reasons for failure to activate the RRS.ConclusionsDespite an organisational commitment to the RRS, clinical staff act on local cultural rules within the clinical environment that are usually not explicit. Better understanding of these informal rules may lead to more appropriate activation of the RRS.

• Publisher: BMJ Publishing Group Ltd,BMJ Publishing Group LTD,BMJ Group
• Subject: Adult / adverse events / Australia - epidemiology / cardiac arrest / cardiac safety / chronic disease management / Clinical Competence - statistics & numerical data / Clinical Protocols - standards / Comparative Effectiveness Research / Confounding Factors (Epidemiology) / Cooperative Behavior / crisis management / Critical Care - utilization / Decision making / Emergency Service, Hospital - organization & administration / Emergency Service, Hospital - standards / Emergency Service, Hospital - statistics & numerical data / epidemiology and detection / Ethics / Health care / Heart Arrest - epidemiology / Heart Arrest - prevention & control / Heart Arrest - therapy / hospital culture / Hospital Mortality - trends / Hospital Rapid Response Team - utilization / Hospitals / Humans / Intensive Care Units - utilization / Interprofessional Relations / medical emergency team (MET) / Medical Errors - statistics & numerical data / Medical Staff, Hospital - psychology / Medical Staff, Hospital - standards / Mortality / Nursing Staff, Hospital - psychology / Nursing Staff, Hospital - statistics & numerical data / Organizational Culture / Original Research / Physiology / Prevalence / Rapid response systems (RRS) / Root Cause Analysis / Studies / Surveys and Questionnaires / Urban Health Services - standards / Urban Health Services - statistics & numerical data