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Title: Critical care clinician perceptions of factors leading to Medical Emergency Team review.
Austin Authors: Currey, Judy;Allen, Josh;Jones, Daryl A 
Affiliation: Public Health and Preventive Medicine, Monash University, Clayton campus, Melbourne, Victoria 3800, Australia
Department of Surgery, University of Melbourne, 1-100 Grattan Street, Melbourne, Victoria 3010, Australia
Intensive Care Unit, Austin Health, Heidelberg, Victoria, Australia
School of Nursing and Midwifery and Centre for Quality and Patient Safety Research, c/- Deakin University, Geelong, Victoria 3146, Australia
Issue Date: Mar-2018 2017-05-05
Publication information: Australian Critical Care 2018; 31(2): 87-92
Abstract: The introduction of rapid response systems has reduced the incidence of in-hospital cardiac arrest; however, many instances of clinical deterioration are unrecognised. Afferent limb failure is common and may be associated with unplanned intensive care admissions, heightened mortality and prolonged length of stay. Patients reviewed by a Medical Emergency Team are inherently vulnerable with a high in-hospital mortality. To explore perceptions of intensive care unit (ICU) staff who attend deteriorating acute care ward patients regarding current problems, barriers and potential solutions to recognising and responding to clinical deterioration that culminates in a Medical Emergency Team review. A descriptive exploratory design was used. Registered intensive care nurses and medical staff (N=207) were recruited during a professional conference using purposive sampling for experience in attending deteriorating patients. Written response surveys were used to address the study aim. Data were analysed using content analysis. Four major themes were identified: Governance, Teamwork, Clinical Care Delivery and End of Life Care. Participants perceived there was a lack of sufficient and senior staff with the required theoretical knowledge; and inadequate assessment and critical thinking skills for anticipating, recognising and responding to clinical deterioration. Senior doctors were perceived to inappropriately manage End of Life Care issues and displayed Teamwork behaviours rendering ward clinicians feeling fearful and intimidated. A lack of System and Clinical Governance hindered identification of clinical deterioration. To improve patient safety related to recognising and responding to clinical deterioration, suboptimal care due to professionals' knowledge, skills and behaviours need addressing, along with End of Life Care and Governance.
DOI: 10.1016/j.aucc.2017.03.003
Journal: Australian Critical Care
PubMed URL: 28483444
ISSN: 1036-7314
Type: Journal Article
Subjects: Clinical deterioration
End of Life Care
Medical Emergency Team
Patient assessment
Patient safety
Rapid response system
Rapid response team
Risk management
Appears in Collections:Journal articles

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