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Title: Factors influencing escalation of care by junior medical officers.
Austin Authors: Rotella, Joe-Anthony ;Yu, W;Ferguson, J;Jones, Daryl A 
Affiliation: Emergency Medicine, Austin Health, Heidelberg, Victoria.
Intensive Care, Austin Health, Heidelberg, Victoria.
Austin Health, Heidelberg, Victoria.
Issue Date: 1-Nov-2014
Publication information: Anaesthesia and Intensive Care; 42(6): 723-9
Abstract: Patients can acutely deteriorate unexpectedly. Junior medical officers (JMOs) are often first to review patients who become unwell. Opportunities to escalate care to a senior colleague may exist prior to the need for a rapid response team review. Little is known about the factors that influence JMO decisions to escalate care. In this study, our objective was to investigate the self-reported factors that influence escalation of care by JMOs in a university-affiliated, tertiary level hospital. We designed a face-to-face questionnaire of JMOs using standardised introduction to minimise interviewer bias. Fifty JMOs participated in the study (a 100% response rate). Most (63.3%) felt that they would be able to identify a clinically deteriorating patient. They would be more likely to escalate care if they were not familiar with the patient's clinical problem. If handover plans were seen to be adequate, JMOs felt it was less necessary to escalate care. Few JMOs (12%) agreed that they limited escalation due to fear of criticism or fear of conflict with senior medical staff. Although 36% agreed that they were concerned about waking seniors overnight, only 6% feared that escalating care overnight would affect their future career prospects. Escalation of care appears to be mostly influenced by the confidence and familiarity of the JMO with the cause of deterioration. JMOs identified clear handover with documented goals of treatment and suggested actions in event of clinical deterioration as the best means by which to improve the process of escalation of care for clinically deteriorating patients.
Gov't Doc #: 25342404
Journal: Anaesthesia and Intensive Care
Type: Journal Article
Subjects: clinical deterioration
escalation of care
junior medical officer
Attitude of Health Personnel
Clinical Competence.statistics & numerical data
Critical Illness
Disease Progression
Hospitals, University.statistics & numerical data
Intensive Care.methods.statistics & numerical data
Internship and Residency.statistics & numerical data
Medical Staff, Hospital.statistics & numerical data
Tertiary Care Centers.statistics & numerical data
Appears in Collections:Journal articles

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