Perceptions of interactions between staff members calling, and those responding to, rapid response team activations for patient deterioration*
Richard Chalwin A B E , Arthas Flabouris B C , Karoline Kapitola D and Leonie Dewick DA Intensive Care Unit, Lyell McEwin Hospital, Haydown Road, Elizabeth Vale, SA 5112, Australia.
B Discipline of Acute Care Medicine, School of Medicine, Faculty of Health Sciences, University of Adelaide, SA 5005, Australia.
C Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia. Email: arthas.flabouris@health.sa.gov.au
D IMPACT Project, Lyell McEwin Hospital, Haydown Road, Elizabeth Vale, SA 5112, Australia. Email: karoline.kapitola@health.sa.gov.au; leonie.dewick@health.sa.gov.au
E Corresponding author. Email: richard.chalwin@adelaide.edu.au
Australian Health Review 40(4) 364-370 https://doi.org/10.1071/AH15138
Submitted: 22 April 2015 Accepted: 7 September 2015 Published: 26 October 2015
Abstract
Objectives The aim of the present study was to investigate experiences of staff interactions and non-technical skills (NTS) at rapid response team (RRT) calls, and their association with repeat RRT calls.
Methods Mixed-methods surveys were conducted of RRT members and staff who activate the RRT (RRT users) for their perceptions and attitudes regarding the use of NTS during RRT calls. Responses within the survey were recorded as Likert items, ranked data and free comments. The latter were coded into nodes relating to one of four NTS domains: leadership, communication, cooperation and planning.
Results Two hundred and ninety-seven (32%) RRT users and 79 (73.8%) RRT members provided responses. Of the RRT user respondents, 76.5% had activated the RRT at some point. Deficits in NTS at RRT calls were revealed, with 36.9% of users not feeling involved during RRT calls and 24.7% of members perceiving that users were disinterested. Unresolved user clinical concerns, or persistence of RRT calling criteria, were reasons cited by 37.6% and 23%, respectively, of RRT users for reactivating an RRT to the same patient. Despite recollections of conflict at previous RRT calls, 92% of users would still reactivate the RRT. The most common theme in the free comments related to deficiencies in cooperation (52.9%), communication (28.6%) and leadership (14.3%).
Conclusions This survey of RRT users and members revealed problems with RRT users’ and members’ interactions at the time of an RRT call. Both users and members considered NTS to be important, but lacking. These findings support NTS training for RRT members and users.
What is known about the topic? Previous surveying has related experiences of criticism and conflict between clinical staff at RRT activations. This leads to reluctance to call the RRT when indicated, with risks to patient safety, especially if subsequent RRT activation is necessary. Training in NTS has improved clinician interactions in simulated emergencies, but the exact role of NTS during RRT calls has not yet been established.
What does this paper add? The present survey examined experienced clinicians’ perceptions of the use of NTS at RRT calls and the effect on subsequent calling. A key finding was a disparity between perceptions of how RRT members interact with those activating the RRT (RRT users) and their performance of NTS. This was reflected with unresolved RRT user clinical concern at the time of a call. In turn, this affected RRT users’ attitudes and intentions to reactivate the RRT. Formal handover was considered desirable by both RRT users and members.
What are the implications for practitioners? The interface between the RRT and those who call the RRT is crucial. This survey shows that RRT users desire to be included in the management of the deteriorating patient and have their concerns addressed before completion of RRT attendance. Failure to do so results in repeat activations to the same patient, with the potential for adverse patient outcomes. Training to include NTS, especially around handover, for RRT members may address this issue and should be explored further.
Additional keywords: crisis resource management, non-technical skills, rapid response system.
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