Exploring interdisciplinary communication pathways for escalating pre-medical emergency team deterioration: a mixed-methods study
Stephanie K. Sprogis
A * , Judy Currey A , Daryl Jones B C D and Julie Considine A E
+ Author Affiliations
- Author Affiliations
A School of Nursing and Midwifery & Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, Vic. 3220, Australia.
B Department of Intensive Care, Austin Hospital, 145 Studley Road, Heidelberg, Vic. 3084, Australia.
C School of Public Health and Preventive Medicine, Monash University, 533 St Kilda Road, Melbourne, Vic. 3004, Australia.
D Department of Surgery, University of Melbourne, Parkville, Vic. 3010, Australia.
E Centre for Quality and Patient Safety Research – Eastern Health Partnership, 2/5 Arnold Street, Box Hill, Vic. 3128, Australia.
* Correspondence to: stephanie.sprogis@research.deakin.edu.au
Australian Health Review 47(4) 494-501 https://doi.org/10.1071/AH22203
Submitted: 6 September 2022 Accepted: 22 June 2023 Published: 18 July 2023
© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA.
Abstract
Objective To explore clinicians’ use and perceptions of interdisciplinary communication pathways for escalating care within the pre-medical emergency team (pre-MET) tier of rapid response systems.
Method A sequential mixed-methods study was conducted using observations and interviews. Participants were clinicians (nurses, allied health, doctors) caring for orthopaedic and general medicine patients at one hospital. Descriptive and thematic analyses were conducted.
Results Escalation practices were observed for 13 of 27 pre-MET events. Leading communication methods for escalating pre-MET events were alphanumeric pagers (61.5%) and in-person discussions (30.8%). Seven escalated pre-MET events led to bedside pre-MET reviews by doctors. Clinician interviews (n = 29) culminated in two themes: challenges in escalation of care, and navigating information gaps. Clinicians reported deficiencies in communication methods for escalating care that hindered interdisciplinary communication and clinical decision-making pertaining to pre-MET deterioration.
Conclusion Policy-defined escalation pathways were inconsistently utilised for pre-MET deterioration. Available communication methods for escalating pre-MET events inadequately fulfilled clinicians’ needs. Variable perceptions of escalation pathways illuminated a lack of of a shared mental model about clinicians’ roles and responsibilities. To optimise timely and appropriate management of patient deterioration, communication infrastructure and interdisciplinary collaboration must be enhanced.
Keywords: clinical deterioration, early medical intervention, hospital rapid response team, interdisciplinary communication, interviews as topic, observation, patient safety, risk management.
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