Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/26058
Title: Understanding the pre-medical emergency team tier of a mature rapid response system: A content analysis of guidance documents.
Austin Authors: Sprogis, Stephanie K;Currey, Judy;Jones, Daryl A ;Considine, Julie
Affiliation: Centre for Quality and Patient Safety Research - Eastern Health Partnership, 2/5 Arnold St, Box Hill, Victoria, 3128, Australia
School of Public Health and Preventive Medicine, Monash University, Wellington Rd, Clayton, Victoria, 3800, Australia
Department of Surgery, University of Melbourne, Parkville, Victoria, 3010, Australia
Deakin University: School of Nursing and Midwifery & Institute for Health Transformation, 1 Gheringhap St, Geelong, Victoria, 3220, Australia
Deakin University: Centre for Quality and Patient Safety Research, 1 Gheringhap St, Geelong, Victoria, 3220, Australia
Deakin University: Deakin Learning Futures, Office of the Deputy Vice Chancellor (Education), 1 Gheringhap St, Geelong, Victoria, 3220, Australia
Intensive Care
Issue Date: 5-Mar-2021
metadata.dc.date: 2021-03-05
Publication information: Australian Critical Care 2021; online first: 5 March
Abstract: The pre-medical emergency team (pre-MET) tier of rapid response systems (RRSs) includes extended activation criteria to identify earlier clinical deterioration and a ward-based patient review that is undertaken by the affected patient's admitting team or covering doctors. There is limited understanding of the structure and processes of the pre-MET RRS tier that are expected to guide clinicians' actions and subsequent patient safety outcomes. The aim of the study was to describe the structure and processes of the pre-MET RRS tier in one acute care setting. An exploratory descriptive design involving document analysis was used. Guidance documents (policies, procedures, guidelines, charts, educational materials) were obtained from one health service with a mature, multitiered RRS in Melbourne, Australia. Documents were analysed using content analysis. Concept- and data-driven approaches were used to construct a coding frame. Nineteen guidance documents supporting the pre-MET RRS tier on general wards were analysed. The coding frame consisted of seven main categories: Defining the Pre-MET RRS Tier, Essential Resources for Operationalisation, Recognising Pre-MET Events, Pathways for Activation, Exceptions to the Rule, Clinician Responses to Pre-MET Events, and Recording Pre-MET Events. The structures and processes of the pre-MET RRS tier were largely consistent with national guidelines, but there were internal inconsistencies in pre-MET activation criteria¬†and unclear recommendations for modifying criteria. Pathways for activating the pre-MET RRS tier were complex and involved many steps, including validation processes before escalation of care to doctors. Responses to pre-MET events were seldom aligned to specific clinician types or groups, with nurses and allied health clinicians being under-represented. We identified opportunities to improve guidance documents supporting the pre-MET RRS tier that may assist other health services engaged in planning or evaluating pre-MET strategies. Further research is needed to understand clinicians' use of the pre-MET RRS tier to inform targeted strategies to optimise its design and implementation.
URI: https://ahro.austin.org.au/austinjspui/handle/1/26058
DOI: 10.1016/j.aucc.2020.12.002
PubMed URL: 33685780
ISSN: 1036-7314
Type: Journal Article
Subjects: Clinical deterioration
Early medical intervention
Health policy
Hospital rapid response team
Nursing
Patient care team
Patient safety
Qualitative research
Systems analysis
Appears in Collections:Journal articles

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