Early warning systems and rapid response to the deteriorating patient in hospital: a systematic realist review.

Research output: Contribution to journalArticle

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Abstract

Aim
To investigate how the mechanisms of implementation and the characteristics of context combine to enable or constrain the implementation of Rapid Response Systems and the achievement of desired outcomes.

Background
There is limited evidence to explain why Rapid Response Systems work or do not work as research to date has primarily focused on measuring patient outcomes without considering the complex nature of the intervention.

Design
Realist Review

Data sources
We searched DARE, CENTRAL, NHSEED, MEDLINE, Medline In Process, Embase, CINAHL, PubMed, Scopus, The Web of Science and PychInfo databases from 1997-2017 in addition to purposively searching the grey literature, citation and snowball searching and contacting professional groups looking for articles supporting, refuting or explaining Rapid Response System programme theories.

Review Methods
Included studies were critically appraised and graded using the Critical Appraisal Skills Programme tool. Data extraction and synthesis investigated the Rapid Response System theoretical propositions against the empirical evidence in order to refine programme theories.

Results
The review found that the Rapid Response System programme theory achieved desired outcomes when there were sufficient skills mix of experienced staff, EWS protocols were used flexibly alongside clinical judgement and staff had access to ongoing, multiprofessional, competency based education. However, ward cultures, hierarchical referral systems, workload and staffing resources impacted negatively on the implementation of the Rapid Response System.

Conclusion
To improve the recognition and management of patient deterioration policymakers need to address those cultural, educational and organisational factors that impact on the successful implementation of Rapid Response Systems in practice.
Original languageEnglish
Pages (from-to)2877-2891
Number of pages15
JournalJournal of Advanced Nursing
Volume73
Issue number12
Early online date20 Jul 2017
DOIs
Publication statusEarly online date - 20 Jul 2017

Keywords

  • EWS protocols; Realist review; nursing; patient deterioration
  • Rapid Response Systems

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