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1. The ACCELERATE Plus (assessment and communication excellence for safe patient outcomes) Trial Protocol: a stepped-wedge cluster randomised trial, cost-benefit analysis, and process evaluation.

Author

Liu, M, Whittam, S, Thornton, A, Goncharov, L, Slade, D, McElduff, B, Kelly, P, Law, CK, Walsh, S, Pollnow, V, Cuffe, J, McMahon, J, Aggar, C, Bilo, J, Bowen, K, Chow, JSF, Duffy, K, Everett, B, Ferguson, C, Frost, SA, Gleeson, N, Hackett, K, Komusanac, I, Marshall, S, May, S, McErlean, G, Melbourne, G, Murphy, J, Newbury, J, Newman, D, Rihari-Thomas, J, Sciuriaga, H, Sturgess, L, Taylor, J, Tuqiri, K, McInnes, E, Middleton, S, ACCELERATE Plus Project Team, Liu, M, Whittam, S, Thornton, A, Goncharov, L, Slade, D, McElduff, B, Kelly, P, Law, CK, Walsh, S, Pollnow, V, Cuffe, J, McMahon, J, Aggar, C, Bilo, J, Bowen, K, Chow, JSF, Duffy, K, Everett, B, Ferguson, C, Frost, SA, Gleeson, N, Hackett, K, Komusanac, I, Marshall, S, May, S, McErlean, G, Melbourne, G, Murphy, J, Newbury, J, Newman, D, Rihari-Thomas, J, Sciuriaga, H, Sturgess, L, Taylor, J, Tuqiri, K, McInnes, E, Middleton, S, and ACCELERATE Plus Project Team

Abstract

BACKGROUND: Nurses play an essential role in patient safety. Inadequate nursing physical assessment and communication in handover practices are associated with increased patient deterioration, falls and pressure injuries. Despite internationally implemented rapid response systems, falls and pressure injury reduction strategies, and recommendations to conduct clinical handovers at patients' bedside, adverse events persist. This trial aims to evaluate the effectiveness, implementation, and cost-benefit of an externally facilitated, nurse-led intervention delivered at the ward level for core physical assessment, structured patient-centred bedside handover and improved multidisciplinary communication. We hypothesise the trial will reduce medical emergency team calls, unplanned intensive care unit admissions, falls and pressure injuries. METHODS: A stepped-wedge cluster randomised trial will be conducted over 52 weeks. The intervention consists of a nursing core physical assessment, structured patient-centred bedside handover and improved multidisciplinary communication and will be implemented in 24 wards across eight hospitals. The intervention will use theoretically informed implementation strategies for changing clinician behaviour, consisting of: nursing executive site engagement; a train-the-trainer model for cascading facilitation; embedded site leads; nursing unit manager leadership training; nursing and medical ward-level clinical champions; ward nurses' education workshops; intervention tailoring; and reminders. The primary outcome will be a composite measure of medical emergency team calls (rapid response calls and 'Code Blue' calls), unplanned intensive care unit admissions, in-hospital falls and hospital-acquired pressure injuries; these measures individually will also form secondary outcomes. Other secondary outcomes are: i) patient-reported experience measures of receiving safe and patient-centred care, ii) nurses' perceptions of barriers to physical assess

Published
2023

3. A unified call to action from Australian nursing and midwifery leaders: Ensuring that Black lives matter

Author

Geia, L., Baird, K., Bail, K., Barclay, L., Bennett, J., Best, O., Birks, M., Blackley, L., Blackman, R., Bonner, A., Bryant AO, R., Buzzacott, C., Campbell, S., Catling, C., Chamberlain, C., Cox, L., Cross, W., Cruickshank, M., Cummins, A., Dahlen, H., Daly, J., Darbyshire, P., Davidson, P., Denney-Wilson, E., de Souza, R., Doyle, K., Drummond, A., Duff, J., Duffield, C., Dunning, T., East, L., Elliott, D., Elmir, R., Fergie OAM, D., Ferguson, C., Fernandez, R., Flower AM, D., Foureur, M., Fowler, C., Fry, M., Gorman, E., Grant, J., Gray, J., Halcomb, E., Hart, B., Hartz, D., Hazelton, M., Heaton, L., Hickman, L., Homer AO, C. S. E., Hungerford, C., Hutton, A., Jackson AO, D., Johnson, A., Kelly, M.A., Kitson, A., Knight, S., Levett-Jones, T., Lindsay, D., Lovett, R., Luck, L., Molloy, L., Manias, E., Mannix, J., Marriott, R., Martin, M., Massey, D., McCloughen, A., McGough, S., McGrath, L., Mills, J., Mitchell, B. G., Mohamed, J., Montayre, J., Moroney, T., Moyle, W., Moxham, L., Northam OAM, H., Nowlan, S., O'Brien, A. P., Ogunsiji, O., Paterson, C., Pennington, K., Peters, K., Phillips, J., Power, T., Procter, N., Ramjan, L., Ramsay, N., Rasmussen, B., Rihari-Thomas, J., Rind, B., Robinson, M., Roche, M., Sainsbury, K., Salamonson, Y., Sherwood, J., Shields, L., Sim, J., Skinner, I., Smallwood, G., Smallwood, R., Stewart, L., Taylor, S., Usher AM, K., Virdun, C., Wannell, J., Ward, R., West, C., West, R., Wilkes, L., Williams, R., Wilson, R., Wynaden, D., Wynne, R., Geia, L., Baird, K., Bail, K., Barclay, L., Bennett, J., Best, O., Birks, M., Blackley, L., Blackman, R., Bonner, A., Bryant AO, R., Buzzacott, C., Campbell, S., Catling, C., Chamberlain, C., Cox, L., Cross, W., Cruickshank, M., Cummins, A., Dahlen, H., Daly, J., Darbyshire, P., Davidson, P., Denney-Wilson, E., de Souza, R., Doyle, K., Drummond, A., Duff, J., Duffield, C., Dunning, T., East, L., Elliott, D., Elmir, R., Fergie OAM, D., Ferguson, C., Fernandez, R., Flower AM, D., Foureur, M., Fowler, C., Fry, M., Gorman, E., Grant, J., Gray, J., Halcomb, E., Hart, B., Hartz, D., Hazelton, M., Heaton, L., Hickman, L., Homer AO, C. S. E., Hungerford, C., Hutton, A., Jackson AO, D., Johnson, A., Kelly, M.A., Kitson, A., Knight, S., Levett-Jones, T., Lindsay, D., Lovett, R., Luck, L., Molloy, L., Manias, E., Mannix, J., Marriott, R., Martin, M., Massey, D., McCloughen, A., McGough, S., McGrath, L., Mills, J., Mitchell, B. G., Mohamed, J., Montayre, J., Moroney, T., Moyle, W., Moxham, L., Northam OAM, H., Nowlan, S., O'Brien, A. P., Ogunsiji, O., Paterson, C., Pennington, K., Peters, K., Phillips, J., Power, T., Procter, N., Ramjan, L., Ramsay, N., Rasmussen, B., Rihari-Thomas, J., Rind, B., Robinson, M., Roche, M., Sainsbury, K., Salamonson, Y., Sherwood, J., Shields, L., Sim, J., Skinner, I., Smallwood, G., Smallwood, R., Stewart, L., Taylor, S., Usher AM, K., Virdun, C., Wannell, J., Ward, R., West, C., West, R., Wilkes, L., Williams, R., Wilson, R., Wynaden, D., and Wynne, R.

Abstract

Nurses and midwives of Australia now is the time for change! As powerfully placed, Indigenous and non-Indigenous nursing and midwifery professionals, together we can ensure an effective and robust Indigenous curriculum in our nursing and midwifery schools of education. Today, Australia finds itself in a shifting tide of social change, where the voices for better and safer health care ring out loud. Voices for justice, equity and equality reverberate across our cities, our streets, homes, and institutions of learning. It is a call for new songlines of reform. The need to embed meaningful Indigenous health curricula is stronger now than it ever was for Australian nursing and midwifery. It is essential that nursing and midwifery leadership continue to build an authentic collaborative environment for Indigenous curriculum development. Bipartisan alliance is imperative for all academic staff to be confident in their teaching and learning experiences with Indigenous health syllabus. This paper is a call out. Now is the time for Indigenous and non-Indigenous nurses and midwives to make a stand together, for justice and equity in our teaching, learning, and practice. Together we will dismantle systems, policy, and practices in health that oppress. The Black Lives Matter movement provides us with a ‘now window’ of accepted dialogue to build a better, culturally safe Australian nursing and midwifery workforce, ensuring that Black Lives Matter in all aspects of health care.

Published
2020

4. A unified call to action from Australian nursing and midwifery leaders: Ensuring that Black lives matter

Author

Geia, Lynore, Baird, K., Bail, K., Barclay, L., Bennett, J., Best, O., Birks, M., Blackley, L., Blackman, R., Bonner, A., Bryant AO, R., Buzzacott, C., Campbell, S., Catling, C., Chamberlain, C., Cox, L., Cross, W., Cruickshank, M., Cummins, A., Dahlen, H., Daly, J., Darbyshire, P., Davidson, P., Denney-Wilson, E., De Souza, R., Doyle, K., Drummond, A., Duff, J., Duffield, Christine M, Dunning, T., East, L., Elliott, D., Elmir, R., Fergie, D., Ferguson, C., Fernandez, R., Flower, D., Foureur, M., Fowler, C., Fry, M., Gorman, E., Grant, J., Gray, J., Halcomb, E., Hart, B., Hartz, D., Hazelton, M., Heaton, L., Hickman, L., Homer, C. S. E., Hungerford, C., Hutton, A., Jackson, D., Johnson, A., Kelly, M. A., Kitson, A., Knight, S., Levett-Jones, T., Lindsay, D., Lovett, R., Luck, L., Molloy, L., Manias, E., Mannix, J., Marriott, A.M.R., Martin, M., Massey, D., McCloughen, A., McGough, S., McGrath, L., Mills, J., Mitchell, B. G., Mohamed, J., Montayre, J., Moroney, T., Moyle, W., Moxham, L., Northam, H., Nowlan, S., O'Brien, A. P., Ogunsiji, O., Paterson, C., Pennington, K., Peters, K., Philips, J., Power, T., Procter, N., Ramjan, L., Ramsay, N., Rasmussen, B., Rihari-Thomas, J., Rind, B., Robinson, M., Roche, M., Sainsbury, K., Salamonson, Y., Sherwood, J., Shields, L., Sim, J., Skinner, I., Smallwood, G., Smallwood, R., Stewart, L., Taylor, S., Usher, K., Virdun, C., Wannell, J., Ward, R., West, C., West, R., Wilkes, L., Williams, R., Wilson, R., Wynaden, D., Wynne, R., Geia, Lynore, Baird, K., Bail, K., Barclay, L., Bennett, J., Best, O., Birks, M., Blackley, L., Blackman, R., Bonner, A., Bryant AO, R., Buzzacott, C., Campbell, S., Catling, C., Chamberlain, C., Cox, L., Cross, W., Cruickshank, M., Cummins, A., Dahlen, H., Daly, J., Darbyshire, P., Davidson, P., Denney-Wilson, E., De Souza, R., Doyle, K., Drummond, A., Duff, J., Duffield, Christine M, Dunning, T., East, L., Elliott, D., Elmir, R., Fergie, D., Ferguson, C., Fernandez, R., Flower, D., Foureur, M., Fowler, C., Fry, M., Gorman, E., Grant, J., Gray, J., Halcomb, E., Hart, B., Hartz, D., Hazelton, M., Heaton, L., Hickman, L., Homer, C. S. E., Hungerford, C., Hutton, A., Jackson, D., Johnson, A., Kelly, M. A., Kitson, A., Knight, S., Levett-Jones, T., Lindsay, D., Lovett, R., Luck, L., Molloy, L., Manias, E., Mannix, J., Marriott, A.M.R., Martin, M., Massey, D., McCloughen, A., McGough, S., McGrath, L., Mills, J., Mitchell, B. G., Mohamed, J., Montayre, J., Moroney, T., Moyle, W., Moxham, L., Northam, H., Nowlan, S., O'Brien, A. P., Ogunsiji, O., Paterson, C., Pennington, K., Peters, K., Philips, J., Power, T., Procter, N., Ramjan, L., Ramsay, N., Rasmussen, B., Rihari-Thomas, J., Rind, B., Robinson, M., Roche, M., Sainsbury, K., Salamonson, Y., Sherwood, J., Shields, L., Sim, J., Skinner, I., Smallwood, G., Smallwood, R., Stewart, L., Taylor, S., Usher, K., Virdun, C., Wannell, J., Ward, R., West, C., West, R., Wilkes, L., Williams, R., Wilson, R., Wynaden, D., and Wynne, R.

Abstract

© 2020 Informa UK Limited, trading as Taylor & Francis Group. Nurses and midwives of Australia now is the time for change! As powerfully placed, Indigenous and non-Indigenous nursing and midwifery professionals, together we can ensure an effective and robust Indigenous curriculum in our nursing and midwifery schools of education. Today, Australia finds itself in a shifting tide of social change, where the voices for better and safer health care ring out loud. Voices for justice, equity and equality reverberate across our cities, our streets, homes, and institutions of learning. It is a call for new songlines of reform. The need to embed meaningful Indigenous health curricula is stronger now than it ever was for Australian nursing and midwifery. It is essential that nursing and midwifery leadership continue to build an authentic collaborative environment for Indigenous curriculum development. Bipartisan alliance is imperative for all academic staff to be confident in their teaching and learning experiences with Indigenous health syllabus. This paper is a call out. Now is the time for Indigenous and non-Indigenous nurses and midwives to make a stand together, for justice and equity in our teaching, learning, and practice. Together we will dismantle systems, policy, and practices in health that oppress. The Black Lives Matter movement provides us with a ‘now window’ of accepted dialogue to build a better, culturally safe Australian nursing and midwifery workforce, ensuring that Black Lives Matter in all aspects of health care.

Published
2020

5. A unified call to action from Australian nursing and midwifery leaders: ensuring that Black lives matter

Author

Geia, L, Baird, K, Bail, K, Barclay, Lesley M, Bennett, James E, Best, O, Birks, M, Blackley, L, Blackman, R, Bonner, A, Bryant, R, Buzzacott, C, Campbell, S, Catling, Christine, Chamberlain, C, Cox, L, Cross, W, Cruickshank, M, Cummins, A, Dahlen, H, Daly, J, Darbyshire, Philip, Davidson, Patricia M, Denney-Wilson, Elizabeth, De Souza, R, Doyle, K, Drummond, A, Duff, J, Duffield, C, Dunning, T, East, Leah, Elliott, D, Elmir, R, Fergie, D, Ferguson, Caleb, Fernandez, Ritin S, Flower, D, Foureur, M, Fowler, Cathrine, Fry, M, Gorman, E, Grant, J, Gray, Joanne, Halcomb, Elizabeth J, Hart, B, Hartz, D, Hazelton, M, Heaton, L, Hickman, Louise, Homer, C, Hungerford, C, Hutton, A, Jackson, Debra, Johnson, A, Kelly, Margaret, Kitson, A, Knight, S, Levett-Jones, Tracy, Lindsay, D, Lovett, Raymond W, Luck, Lauretta, Molloy, Luke J, Manias, E, Mannix, Judy, Marriott, A, Martin, M, Massey, D, McCloughen, Andrea, McGough, S, McGrath, L, Mills, J, Mitchell, Brett, Mohamed, J, Montayre, J, Moroney, Tracey, Moyle, Wendy, Moxham, Lorna, Northam, H, Nowlan, S, O'Brien, A, Ogunsiji, O, Paterson, C, Pennington, K, Peters, Kathleen, Phillips, Jane, Power, Tamara, Procter, Nicholas, Ramjan, Lucie, Ramsay, N, Rasmussen, B, Rihari-Thomas, J, Rind, B, Robinson, M, Roche, Michael, Sainsbury, K, Salamonson, Yenna, Sherwood, J, Shields, L, Sim, Jenny, Skinner, J, Smallwood, G, Smallwood, R, Stewart, L, Taylor, S, Usher, K, Virdun, C, Wannell, J, Ward, R, West, C, West, R, Wilkes, Lesley, Williams, R, Wilson, Rhonda, Wynaden, D, Wynne, R, Geia, L, Baird, K, Bail, K, Barclay, Lesley M, Bennett, James E, Best, O, Birks, M, Blackley, L, Blackman, R, Bonner, A, Bryant, R, Buzzacott, C, Campbell, S, Catling, Christine, Chamberlain, C, Cox, L, Cross, W, Cruickshank, M, Cummins, A, Dahlen, H, Daly, J, Darbyshire, Philip, Davidson, Patricia M, Denney-Wilson, Elizabeth, De Souza, R, Doyle, K, Drummond, A, Duff, J, Duffield, C, Dunning, T, East, Leah, Elliott, D, Elmir, R, Fergie, D, Ferguson, Caleb, Fernandez, Ritin S, Flower, D, Foureur, M, Fowler, Cathrine, Fry, M, Gorman, E, Grant, J, Gray, Joanne, Halcomb, Elizabeth J, Hart, B, Hartz, D, Hazelton, M, Heaton, L, Hickman, Louise, Homer, C, Hungerford, C, Hutton, A, Jackson, Debra, Johnson, A, Kelly, Margaret, Kitson, A, Knight, S, Levett-Jones, Tracy, Lindsay, D, Lovett, Raymond W, Luck, Lauretta, Molloy, Luke J, Manias, E, Mannix, Judy, Marriott, A, Martin, M, Massey, D, McCloughen, Andrea, McGough, S, McGrath, L, Mills, J, Mitchell, Brett, Mohamed, J, Montayre, J, Moroney, Tracey, Moyle, Wendy, Moxham, Lorna, Northam, H, Nowlan, S, O'Brien, A, Ogunsiji, O, Paterson, C, Pennington, K, Peters, Kathleen, Phillips, Jane, Power, Tamara, Procter, Nicholas, Ramjan, Lucie, Ramsay, N, Rasmussen, B, Rihari-Thomas, J, Rind, B, Robinson, M, Roche, Michael, Sainsbury, K, Salamonson, Yenna, Sherwood, J, Shields, L, Sim, Jenny, Skinner, J, Smallwood, G, Smallwood, R, Stewart, L, Taylor, S, Usher, K, Virdun, C, Wannell, J, Ward, R, West, C, West, R, Wilkes, Lesley, Williams, R, Wilson, Rhonda, Wynaden, D, and Wynne, R

Abstract

Nurses and midwives of Australia now is the time for change! As powerfully placed, Indigenous and non-Indigenous nursing and midwifery professionals, together we can ensure an effective and robust Indigenous curriculum in our nursing and midwifery schools of education. Today, Australia finds itself in a shifting tide of social change, where the voices for better and safer health care ring out loud. Voices for justice, equity and equality reverberate across our cities, our streets, homes, and institutions of learning. It is a call for new songlines of reform. The need to embed meaningful Indigenous health curricula is stronger now than it ever was for Australian nursing and midwifery. It is essential that nursing and midwifery leadership continue to build an authentic collaborative environment for Indigenous curriculum development. Bipartisan alliance is imperative for all academic staff to be confident in their teaching and learning experiences with Indigenous health syllabus. This paper is a call out. Now is the time for Indigenous and non-Indigenous nurses and midwives to make a stand together, for justice and equity in our teaching, learning, and practice. Together we will dismantle systems, policy, and practices in health that oppress. The Black Lives Matter movement provides us with a ‘now window’ of accepted dialogue to build a better, culturally safe Australian nursing and midwifery workforce, ensuring that Black Lives Matter in all aspects of health care.

Published
2020

6. A unified call to action from Australian nursing and midwifery leaders: ensuring that Black lives matter

Author

Geia, L., primary, Baird, K., additional, Bail, K., additional, Barclay, L., additional, Bennett, J., additional, Best, O., additional, Birks, M., additional, Blackley, L., additional, Blackman, R., additional, Bonner, A., additional, Bryant AO, R., additional, Buzzacott, C., additional, Campbell, S., additional, Catling, C., additional, Chamberlain, C., additional, Cox, L., additional, Cross, W., additional, Cruickshank, M., additional, Cummins, A., additional, Dahlen, H., additional, Daly, J., additional, Darbyshire, P., additional, Davidson, P., additional, Denney-Wilson, E., additional, De Souza, R., additional, Doyle, K., additional, Drummond, A., additional, Duff, J., additional, Duffield, C., additional, Dunning, T., additional, East, L., additional, Elliott, D., additional, Elmir, R., additional, Fergie OAM, D., additional, Ferguson, C., additional, Fernandez, R., additional, Flower AM, D., additional, Foureur, M., additional, Fowler, C., additional, Fry, M., additional, Gorman, E., additional, Grant, J., additional, Gray, J., additional, Halcomb, E., additional, Hart, B., additional, Hartz, D., additional, Hazelton, M., additional, Heaton, L., additional, Hickman, L., additional, Homer AO, C. S. E., additional, Hungerford, C., additional, Hutton, A., additional, Jackson AO, D., additional, Johnson, A., additional, Kelly, M. A., additional, Kitson, A., additional, Knight, S., additional, Levett-Jones, T., additional, Lindsay, D., additional, Lovett, R., additional, Luck, L., additional, Molloy, L., additional, Manias, E., additional, Mannix, J., additional, Marriott, A. M. R., additional, Martin, M., additional, Massey, D., additional, McCloughen, A., additional, McGough, S., additional, McGrath, L., additional, Mills, J., additional, Mitchell, B. G., additional, Mohamed, J., additional, Montayre, J., additional, Moroney, T., additional, Moyle, W., additional, Moxham, L., additional, Northam OAM, H., additional, Nowlan, S., additional, O'Brien, A. P., additional, Ogunsiji, O., additional, Paterson, C., additional, Pennington, K., additional, Peters, K., additional, Phillips, J., additional, Power, T., additional, Procter, N., additional, Ramjan, L., additional, Ramsay, N., additional, Rasmussen, B., additional, Rihari-Thomas, J., additional, Rind, B., additional, Robinson, M., additional, Roche, M., additional, Sainsbury, K., additional, Salamonson, Y., additional, Sherwood, J., additional, Shields, L., additional, Sim, J., additional, Skinner, I., additional, Smallwood, G., additional, Smallwood, R., additional, Stewart, L., additional, Taylor, S., additional, Usher AM, K., additional, Virdun, C., additional, Wannell, J., additional, Ward, R., additional, West, C., additional, West, R., additional, Wilkes, L., additional, Williams, R., additional, Wilson, R., additional, Wynaden, D., additional, and Wynne, R., additional

Published
2020
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7. The rapid response system: an integrative review

Author

Rihari-Thomas, J, DiGiacomo, M, Newton, P, Sibbritt, D, Davidson, PM, Rihari-Thomas, J, DiGiacomo, M, Newton, P, Sibbritt, D, and Davidson, PM

Abstract

© 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group. Background: Clinical deterioration and adverse events in hospitals is an increasing cause for concern. Rapid response systems have been widely implemented to identify deteriorating patients. Aim: We aimed to examine the literature highlighting major historical trends leading to the widespread adoption of rapid response systems, focussing on Australian issues and identifying future focus areas. Method: Integrative literature review including published and grey literature. Results: Seventy-eight sources including journal articles and Australian government matierlas resulted. Pertinent themes were the increasing acuity and aging of the population, importance of hospital cultures, the emerging role of the consumer, and proliferation, evolution and standardisation of rapid response systems. Discussion: Translating evidence to usual care practice is challenging and strongly driven by local factors and political imperatives. Conclusion: Rapid response systems are complex interventions requiring consideration of contextual factors at all levels. Appropriate resources, a skilled workforce and positive workplace cultures are needed for these systems to reach their full potential.

Published
2019

9. Clinician perspectives of barriers to effective implementation of a rapid response system in an academic health centre: A focus group study

Author

Rihari-Thomas, J, Digiacomo, M, Phillips, J, Newton, P, Davidson, PM, Rihari-Thomas, J, Digiacomo, M, Phillips, J, Newton, P, and Davidson, PM

Abstract

© 2017 The Author(s). Background: Systemic and structural issues of rapid response system (RRS) models can hinder implementation. This study sought to understand the ways in which acute care clinicians (physicians and nurses) experience and negotiate care for deteriorating patients within the RRS. Methods: Physicians and nurses working within an Australian academic health centre within a jurisdictional-based model of clinical governance participated in focus group interviews. Verbatim transcripts were analysed using thematic content analysis. Results: Thirty-four participants (21 physicians and 13 registered nurses [RNs]) participated in six focus groups over five weeks in 2014. Implementing the RRS in daily practice was a process of informal communication and negotiation in spite of standardised protocols. Themes highlighted several systems or organisational-level barriers to an effective RRS, including (1) responsibility is inversely proportional to clinical experience; (2) actions around system flexibility contribute to deviation from protocol; (3) misdistribution of resources leads to perceptions of inadequate staffing levels inhibiting full optimisation of the RRS; and (4) poor communication and documentation of RRS increases clinician workloads. Conclusion: Implementing a RRS is complex and multifactorial, influenced by various inter- and intra-professional factors, staffing models and organisational culture. The RRS is not a static model; it is both reflexive and iterative, perpetually transforming to meet healthcare consumer and provider demands and local unit contexts and needs. Requiring more than just a strong initial implementation phase, new models of care such as a RRS demand good governance processes, ongoing support and regular evaluation and refinement. Cultural, organizational and professional factors, as well as systems-based processes, require consideration if RRSs are to achieve their intended outcomes in dynamic healthcare settings.

Published
2017

10. A unified call to action from Australian nursing and midwifery leaders: Ensuring that Black lives matter

Author

Geia, Lynore, Baird, K., Bail, K., Barclay, L., Bennett, J., Best, O., Birks, M., Blackley, L., Blackman, R., Bonner, A., Bryant AO, R., Buzzacott, C., Campbell, S., Catling, C., Chamberlain, C., Cox, L., Cross, W., Cruickshank, M., Cummins, A., Dahlen, H., Daly, J., Darbyshire, P., Davidson, P., Denney-Wilson, E., De Souza, R., Doyle, K., Drummond, A., Duff, J., Duffield, Christine M, Dunning, T., East, L., Elliott, D., Elmir, R., Fergie, D., Ferguson, C., Fernandez, R., Flower, D., Foureur, M., Fowler, C., Fry, M., Gorman, E., Grant, J., Gray, J., Halcomb, E., Hart, B., Hartz, D., Hazelton, M., Heaton, L., Hickman, L., Homer, C. S. E., Hungerford, C., Hutton, A., Jackson, D., Johnson, A., Kelly, M. A., Kitson, A., Knight, S., Levett-Jones, T., Lindsay, D., Lovett, R., Luck, L., Molloy, L., Manias, E., Mannix, J., Marriott, A.M.R., Martin, M., Massey, D., McCloughen, A., McGough, S., McGrath, L., Mills, J., Mitchell, B. G., Mohamed, J., Montayre, J., Moroney, T., Moyle, W., Moxham, L., Northam, H., Nowlan, S., O'Brien, A. P., Ogunsiji, O., Paterson, C., Pennington, K., Peters, K., Philips, J., Power, T., Procter, N., Ramjan, L., Ramsay, N., Rasmussen, B., Rihari-Thomas, J., Rind, B., Robinson, M., Roche, M., Sainsbury, K., Salamonson, Y., Sherwood, J., Shields, L., Sim, J., Skinner, I., Smallwood, G., Smallwood, R., Stewart, L., Taylor, S., Usher, K., Virdun, C., Wannell, J., Ward, R., West, C., West, R., Wilkes, L., Williams, R., Wilson, R., Wynaden, D., Wynne, R., Geia, Lynore, Baird, K., Bail, K., Barclay, L., Bennett, J., Best, O., Birks, M., Blackley, L., Blackman, R., Bonner, A., Bryant AO, R., Buzzacott, C., Campbell, S., Catling, C., Chamberlain, C., Cox, L., Cross, W., Cruickshank, M., Cummins, A., Dahlen, H., Daly, J., Darbyshire, P., Davidson, P., Denney-Wilson, E., De Souza, R., Doyle, K., Drummond, A., Duff, J., Duffield, Christine M, Dunning, T., East, L., Elliott, D., Elmir, R., Fergie, D., Ferguson, C., Fernandez, R., Flower, D., Foureur, M., Fowler, C., Fry, M., Gorman, E., Grant, J., Gray, J., Halcomb, E., Hart, B., Hartz, D., Hazelton, M., Heaton, L., Hickman, L., Homer, C. S. E., Hungerford, C., Hutton, A., Jackson, D., Johnson, A., Kelly, M. A., Kitson, A., Knight, S., Levett-Jones, T., Lindsay, D., Lovett, R., Luck, L., Molloy, L., Manias, E., Mannix, J., Marriott, A.M.R., Martin, M., Massey, D., McCloughen, A., McGough, S., McGrath, L., Mills, J., Mitchell, B. G., Mohamed, J., Montayre, J., Moroney, T., Moyle, W., Moxham, L., Northam, H., Nowlan, S., O'Brien, A. P., Ogunsiji, O., Paterson, C., Pennington, K., Peters, K., Philips, J., Power, T., Procter, N., Ramjan, L., Ramsay, N., Rasmussen, B., Rihari-Thomas, J., Rind, B., Robinson, M., Roche, M., Sainsbury, K., Salamonson, Y., Sherwood, J., Shields, L., Sim, J., Skinner, I., Smallwood, G., Smallwood, R., Stewart, L., Taylor, S., Usher, K., Virdun, C., Wannell, J., Ward, R., West, C., West, R., Wilkes, L., Williams, R., Wilson, R., Wynaden, D., and Wynne, R.

Abstract

Geia, L., Baird, K., Bail, K., Barclay, L., Bennett, J., Best, O., ... Wynne, R. (2020). A unified call to action from Australian nursing and midwifery leaders: Ensuring that Black lives matter. Contemporary Nurse, 56(4), 297-308. https://doi.org/10.1080/10376178.2020.1809107

11. A unified call to action from Australian Nursing and Midwifery leaders: ensuring that Black Lives Matter

Author

Geia, L, Baird, K, Bail, K, Barclay, L, Bennett, J, Best, O, Birks, M, Blackley, L, Blackman, R, Bonner, A, Bryant AO, R, Kitson, A, Knight, S, Levett-Jones, T, Lindsay, D, Lovett, R, Luck, L, Malloy, L, Manias, E, Mannix, J, Marriott AM, R, Mills, J, Martin, M, Massey, D, McCloughen, A, McGough, S, McGrath, L, Mitchell, B, Mohamed, J, Montayre, J, Moroney, T, Moyle, W, Moxham, L, Northam AM, H, Nowlan, S, O'Brien, T, Power, T, Ogunsiji, O, Patterson, C, Pennington, K, Peters, K, Phillips, J, Procter, N, Ramjan, L, Ramsay, N, Rasmussen, B, Rihari-Thomas, J, Rind, B, Robinson, M, Roche, M, Sainsbury, K, Smallwood, G, Salamonson, Y, Sherwood, J, Shields, L, Sim, J, Skinner, I, Smallwood, R, Stewart, L, Taylor, S, Usher AM, K, Virdun, C, Wannell, J, Ward, R, West, C, West, R, Buzzacott, C, Wilkes, L, Williams, R, Wilson, R, Wynaden, D, Wynn, R, Campbell, S, Catling, C, Chamberlain, C, Cox, L, Cross, W, Cruickshank, M, Cummins, A, Dahlen, H, Daly, J, Darbyshire, P, Davidson, P, Denny-Wilson, E, De Souza, R, Doyle, K, Drummond, A, Duff, J, Duffield, C, Dunning, T, East, L, Elliott, D, Elmir, R, Fergie, D, Ferguson, C, Fernandez, R, Flower AM, D, Foureur, M, Fowler, C, Fry, M, Gorman, E, Grant, J, Gray, J, Halcomb, E, Hart, B, Hartz, D, Hazelton, M, Heaton, L, Hickman, L, Homer, C, Hungerford, C, Hutton, A, Jackson AO, D, Johnson, A, Kelly, M, Geia, L, Baird, K, Bail, K, Barclay, L, Bennett, J, Best, O, Birks, M, Blackley, L, Blackman, R, Bonner, A, Bryant AO, R, Kitson, A, Knight, S, Levett-Jones, T, Lindsay, D, Lovett, R, Luck, L, Malloy, L, Manias, E, Mannix, J, Marriott AM, R, Mills, J, Martin, M, Massey, D, McCloughen, A, McGough, S, McGrath, L, Mitchell, B, Mohamed, J, Montayre, J, Moroney, T, Moyle, W, Moxham, L, Northam AM, H, Nowlan, S, O'Brien, T, Power, T, Ogunsiji, O, Patterson, C, Pennington, K, Peters, K, Phillips, J, Procter, N, Ramjan, L, Ramsay, N, Rasmussen, B, Rihari-Thomas, J, Rind, B, Robinson, M, Roche, M, Sainsbury, K, Smallwood, G, Salamonson, Y, Sherwood, J, Shields, L, Sim, J, Skinner, I, Smallwood, R, Stewart, L, Taylor, S, Usher AM, K, Virdun, C, Wannell, J, Ward, R, West, C, West, R, Buzzacott, C, Wilkes, L, Williams, R, Wilson, R, Wynaden, D, Wynn, R, Campbell, S, Catling, C, Chamberlain, C, Cox, L, Cross, W, Cruickshank, M, Cummins, A, Dahlen, H, Daly, J, Darbyshire, P, Davidson, P, Denny-Wilson, E, De Souza, R, Doyle, K, Drummond, A, Duff, J, Duffield, C, Dunning, T, East, L, Elliott, D, Elmir, R, Fergie, D, Ferguson, C, Fernandez, R, Flower AM, D, Foureur, M, Fowler, C, Fry, M, Gorman, E, Grant, J, Gray, J, Halcomb, E, Hart, B, Hartz, D, Hazelton, M, Heaton, L, Hickman, L, Homer, C, Hungerford, C, Hutton, A, Jackson AO, D, Johnson, A, and Kelly, M

12. A unified call to action from Australian Nursing and Midwifery leaders: ensuring that Black Lives Matter

Author

Geia, L, Baird, K, Bail, K, Barclay, L, Bennett, J, Best, O, Birks, M, Blackley, L, Blackman, R, Bonner, A, Bryant AO, R, Kitson, A, Knight, S, Levett-Jones, T, Lindsay, D, Lovett, R, Luck, L, Malloy, L, Manias, E, Mannix, J, Marriott AM, R, Mills, J, Martin, M, Massey, D, McCloughen, A, McGough, S, McGrath, L, Mitchell, B, Mohamed, J, Montayre, J, Moroney, T, Moyle, W, Moxham, L, Northam AM, H, Nowlan, S, O'Brien, T, Power, T, Ogunsiji, O, Patterson, C, Pennington, K, Peters, K, Phillips, J, Procter, N, Ramjan, L, Ramsay, N, Rasmussen, B, Rihari-Thomas, J, Rind, B, Robinson, M, Roche, M, Sainsbury, K, Smallwood, G, Salamonson, Y, Sherwood, J, Shields, L, Sim, J, Skinner, I, Smallwood, R, Stewart, L, Taylor, S, Usher AM, K, Virdun, C, Wannell, J, Ward, R, West, C, West, R, Buzzacott, C, Wilkes, L, Williams, R, Wilson, R, Wynaden, D, Wynn, R, Campbell, S, Catling, C, Chamberlain, C, Cox, L, Cross, W, Cruickshank, M, Cummins, A, Dahlen, H, Daly, J, Darbyshire, P, Davidson, P, Denny-Wilson, E, De Souza, R, Doyle, K, Drummond, A, Duff, J, Duffield, C, Dunning, T, East, L, Elliott, D, Elmir, R, Fergie, D, Ferguson, C, Fernandez, R, Flower AM, D, Foureur, M, Fowler, C, Fry, M, Gorman, E, Grant, J, Gray, J, Halcomb, E, Hart, B, Hartz, D, Hazelton, M, Heaton, L, Hickman, L, Homer, C, Hungerford, C, Hutton, A, Jackson AO, D, Johnson, A, Kelly, M, Geia, L, Baird, K, Bail, K, Barclay, L, Bennett, J, Best, O, Birks, M, Blackley, L, Blackman, R, Bonner, A, Bryant AO, R, Kitson, A, Knight, S, Levett-Jones, T, Lindsay, D, Lovett, R, Luck, L, Malloy, L, Manias, E, Mannix, J, Marriott AM, R, Mills, J, Martin, M, Massey, D, McCloughen, A, McGough, S, McGrath, L, Mitchell, B, Mohamed, J, Montayre, J, Moroney, T, Moyle, W, Moxham, L, Northam AM, H, Nowlan, S, O'Brien, T, Power, T, Ogunsiji, O, Patterson, C, Pennington, K, Peters, K, Phillips, J, Procter, N, Ramjan, L, Ramsay, N, Rasmussen, B, Rihari-Thomas, J, Rind, B, Robinson, M, Roche, M, Sainsbury, K, Smallwood, G, Salamonson, Y, Sherwood, J, Shields, L, Sim, J, Skinner, I, Smallwood, R, Stewart, L, Taylor, S, Usher AM, K, Virdun, C, Wannell, J, Ward, R, West, C, West, R, Buzzacott, C, Wilkes, L, Williams, R, Wilson, R, Wynaden, D, Wynn, R, Campbell, S, Catling, C, Chamberlain, C, Cox, L, Cross, W, Cruickshank, M, Cummins, A, Dahlen, H, Daly, J, Darbyshire, P, Davidson, P, Denny-Wilson, E, De Souza, R, Doyle, K, Drummond, A, Duff, J, Duffield, C, Dunning, T, East, L, Elliott, D, Elmir, R, Fergie, D, Ferguson, C, Fernandez, R, Flower AM, D, Foureur, M, Fowler, C, Fry, M, Gorman, E, Grant, J, Gray, J, Halcomb, E, Hart, B, Hartz, D, Hazelton, M, Heaton, L, Hickman, L, Homer, C, Hungerford, C, Hutton, A, Jackson AO, D, Johnson, A, and Kelly, M

13. Care quality and safety in long-term aged care settings: A systematic review and narrative analysis of missed care measurements.

Author

Wang X, Rihari-Thomas J, Bail K, Bala N, and Traynor V

Abstract

Aim: To critically evaluate missed care measurement approaches and their application in long-term aged care (LTAC) settings., Design: Systematic review using Tawfik's guideline., Data Sources: PubMed, Scopus, Web of Science, CINAHL and ProQuest were searched. Supplemental searching was from reference lists of retrieved records, first authors' ORCID homepages and Google advanced search for grey literature. Search limitations were English language, published between 1 January 2001 and 31 December 2022., Review Method: COVIDENCE was utilized for screening, data extraction and quality appraisal. JBI Critical Appraisal Tools and COSMIN Risk of Bias Tool were used for quality appraisal. Data were summarized and synthesized using narrative analysis., Results: Twenty-four publications across 11 regions were included, with two principal methods of missed care measurement: modified standard scales and tailored specific approaches. They were applied inconsistently and generated diverse measurement outcomes. There were challenges even with the most commonly used tool, the BERNCA-NH, including absence of high-quality verification through comparative analysis against an established 'gold standard', reliance on self-administration, incomplete assessment of constructs and inadequate exploration of psychometric properties., Conclusion: Globally, there are deficiencies in the effectiveness and comprehensiveness of the instruments measuring missed care in LTAC settings. Further research on theoretical and practical perspectives is required., Implications: Findings highlighted a critical need to establish a standardized, validated approach to measure missed care in LTAC settings. This review calls for collaborative efforts by researchers, clinical staff and policymakers to develop and implement evidence-based practices as a way of safeguarding the well-being of older clients living in LTAC settings., Impact: Measurements of missed care in LTAC settings rely on adapting acute care tools. There is a critical gap in measuring missed care in LTAC settings. Developing a new tool could improve care quality and safety in LTAC settings globally., Reporting Method: Adhered to PRISMA guideline., Patient or Public Contribution: No patient or public contribution., (© 2024 The Author(s). Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Published
2024
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14. Advanced practice nurses' experiences of patient safety: a focus group study.

Author

Glarcher M, Rihari-Thomas J, Duffield C, Tuqiri K, Hackett K, and Ferguson C

Abstract

Background: Patient harm from unsafe care is an increasingly global phenomenon leading to death or disability. Drawing on their expertise, Advanced Practice Nurses provide the opportunity to improve care quality and safety., Aim: To explore Nurse Practitioners and Clinical Nurse Consultants' experiences in patient safety., Design: A qualitative design was used involving six audio-visually recorded focus group interviews. Participants working in an acute or community adult nursing speciality were involved., Methods: Twenty-eight Advanced Practice Nurses (female 82.1%, mean age 47.5 ± 10 years) were recruited by convenience and snowball sampling. After transcription of interview data, qualitative content analysis was conducted., Results: Six categories were identified: patient safety as the highest priority (1), special contribution to patient safety (2), patients/relatives role in safety (3), multidisciplinary team approach (4), government regulation in safety (5), and further needs to improve safety (6). Advanced Practice Nurses saw themselves as role models and leaders for other healthcare staff through their expertise and professional experience and thus able to see the bigger picture in health. They identified as change agents at the system-level due to their decision-making ability and multi-professional team connectivity., Conclusions: This study emphasises the key position of extended nursing roles and the need for future development of patient safety strategies in hospitals and community care. As influential leaders, Advanced Practice Nurses are best placed to identify improvements. They play a central role in guiding the multi-professional team, the patient and their family, educating nursing staff, and identifying and addressing system-wide safety gaps to improve patient safety.

Published
2024
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15. Transforming nursing assessment in acute hospitals: A cluster randomised controlled trial of an evidence-based nursing core assessment (the ENCORE trial).

Author

Douglas C, Alexeev S, Middleton S, Gardner G, Kelly P, McInnes E, Rihari-Thomas J, Windsor C, and Morton RL

Subjects
Humans, Australia, Evidence-Based Nursing, Hospitalization, Hospitals, Clinical Deterioration
Abstract

Background: Patient safety is threatened when early signs of clinical deterioration are missed or not acted upon. This research began as a clinical-academic partnership established around a shared concern of nursing physical assessment practices on general wards and delayed recognition of clinical deterioration. The outcome was the development of a complex intervention facilitated at the ward level for proactive nursing surveillance., Methods: The evidence-based nursing core assessment (ENCORE) trial was a pragmatic cluster-randomised controlled trial. We hypothesised that ward intervention would reduce the incidence of patient rescue events (medical emergency team activations) and serious adverse events. We randomised 29 general wards in a 1:2 allocation, across 5 Australian hospitals to intervention (n = 10) and usual care wards (n = 19). Skilled facilitation over 12 months enabled practitioner-led, ward-level practice change for proactive nursing surveillance. The primary outcome was the rate of medical emergency team activations and secondary outcomes were unplanned intensive care unit admissions, on-ward resuscitations, and unexpected deaths. Outcomes were prospectively collected for 6 months following the initial 6 months of implementation. Analysis was at the patient level using generalised linear mixed models to account for clustering by ward., Results: We analysed 29,385 patient admissions to intervention (n = 11,792) and control (n = 17,593) wards. Adjusted models for overall effects suggested the intervention increased the rate of medical emergency team activations (adjusted incidence rate ratio 1.314; 95 % confidence interval 0.975, 1.773), although the confidence interval was compatible with a marginal decrease to a substantial increase in rate. Confidence intervals for secondary outcomes included a range of plausible effects from benefit to harm. However, considerable heterogeneity was observed in intervention effects by patient comorbidity. Among patients with few comorbid conditions in the intervention arm there was a lower medical emergency team activation rate and decreased odds of unexpected death. Among patients with multimorbidity in the intervention arm there were higher rates of medical emergency team activation and intensive care unit admissions., Conclusion: Trial outcomes have refined our assumptions about the impact of the ENCORE intervention. The intervention appears to have protective effects for patients with low complexity where frontline teams can respond locally. It also appears to have redistributed medical emergency team activations and unplanned intensive care unit admissions, mobilising higher rates of rescue for patients with multimorbidity., Trial Registration Number: ACTRN12618001903279 (Date of registration: 22/11/2018; First participant recruited: 01/02/2019)., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Published
2024
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16. Correction: the ACCELERATE Plus (assessment and communication excellence for safe patient outcomes) Trial Protocol: a stepped-wedge cluster randomised trial, cost-benefit analysis, and process evaluation.

Author

Liu M, Whittam S, Thornton A, Goncharov L, Slade D, McElduff B, Kelly P, Law CK, Walsh S, Pollnow V, Cuffe J, McMahon J, Aggar C, Bilo J, Bowen K, Chow JSF, Duffy K, Everett B, Ferguson C, Frost SA, Gleeson N, Hackett K, Komusanac I, Marshall S, May S, McErlean G, Melbourne G, Murphy J, Newbury J, Newman D, Rihari-Thomas J, Sciuriaga H, Sturgess L, Taylor J, Tuqiri K, McInnes E, and Middleton S

Published
2023
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17. The ACCELERATE Plus (assessment and communication excellence for safe patient outcomes) Trial Protocol: a stepped-wedge cluster randomised trial, cost-benefit analysis, and process evaluation.

Author

Liu M, Whittam S, Thornton A, Goncharov L, Slade D, McElduff B, Kelly P, Law CK, Walsh S, Pollnow V, Cuffe J, McMahon J, Aggar C, Bilo J, Bowen K, Chow JSF, Duffy K, Everett B, Ferguson C, Frost SA, Gleeson N, Hackett K, Komusanac I, Marshall S, May S, McErlean G, Melbourne G, Murphy J, Newbury J, Newman D, Rihari-Thomas J, Sciuriaga H, Sturgess L, Taylor J, Tuqiri K, McInnes E, and Middleton S

Abstract

Background: Nurses play an essential role in patient safety. Inadequate nursing physical assessment and communication in handover practices are associated with increased patient deterioration, falls and pressure injuries. Despite internationally implemented rapid response systems, falls and pressure injury reduction strategies, and recommendations to conduct clinical handovers at patients' bedside, adverse events persist. This trial aims to evaluate the effectiveness, implementation, and cost-benefit of an externally facilitated, nurse-led intervention delivered at the ward level for core physical assessment, structured patient-centred bedside handover and improved multidisciplinary communication. We hypothesise the trial will reduce medical emergency team calls, unplanned intensive care unit admissions, falls and pressure injuries., Methods: A stepped-wedge cluster randomised trial will be conducted over 52 weeks. The intervention consists of a nursing core physical assessment, structured patient-centred bedside handover and improved multidisciplinary communication and will be implemented in 24 wards across eight hospitals. The intervention will use theoretically informed implementation strategies for changing clinician behaviour, consisting of: nursing executive site engagement; a train-the-trainer model for cascading facilitation; embedded site leads; nursing unit manager leadership training; nursing and medical ward-level clinical champions; ward nurses' education workshops; intervention tailoring; and reminders. The primary outcome will be a composite measure of medical emergency team calls (rapid response calls and 'Code Blue' calls), unplanned intensive care unit admissions, in-hospital falls and hospital-acquired pressure injuries; these measures individually will also form secondary outcomes. Other secondary outcomes are: i) patient-reported experience measures of receiving safe and patient-centred care, ii) nurses' perceptions of barriers to physical assessment, readiness to change, and staff engagement, and iii) nurses' and medical officers' perceptions of safety culture and interprofessional collaboration. Primary outcome data will be collected for the trial duration, and secondary outcome surveys will be collected prior to each step and at trial conclusion. A cost-benefit analysis and post-trial process evaluation will also be undertaken., Discussion: If effective, this intervention has the potential to improve nursing care, reduce patient harm and improve patient outcomes. The evidence-based implementation strategy has been designed to be embedded within existing hospital workforces; if cost-effective, it will be readily translatable to other hospitals nationally., Trial Registration: Australian New Zealand Clinical Trials Registry ID: ACTRN12622000155796. Date registered: 31/01/2022., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Published
2023
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19. The rapid response system: an integrative review.

Author

Rihari-Thomas J, DiGiacomo M, Newton P, Sibbritt D, and Davidson PM

Subjects
Adult, Aged, Aged, 80 and over, Australia, Female, Forecasting, Humans, Male, Middle Aged, Clinical Deterioration, Emergency Medical Services statistics & numerical data, Emergency Medical Services trends, Hospital Rapid Response Team statistics & numerical data, Hospital Rapid Response Team trends
Abstract

Background: Clinical deterioration and adverse events in hospitals is an increasing cause for concern. Rapid response systems have been widely implemented to identify deteriorating patients. Aim: We aimed to examine the literature highlighting major historical trends leading to the widespread adoption of rapid response systems, focussing on Australian issues and identifying future focus areas. Method: Integrative literature review including published and grey literature. Results: Seventy-eight sources including journal articles and Australian government matierlas resulted. Pertinent themes were the increasing acuity and aging of the population, importance of hospital cultures, the emerging role of the consumer, and proliferation, evolution and standardisation of rapid response systems. Discussion: Translating evidence to usual care practice is challenging and strongly driven by local factors and political imperatives. Conclusion: Rapid response systems are complex interventions requiring consideration of contextual factors at all levels. Appropriate resources, a skilled workforce and positive workplace cultures are needed for these systems to reach their full potential.

Published
2019
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21. Clinician Perspectives of Barriers to Effective Implementation of a Rapid Response System in an Academic Health Centre: A Focus Group Study.

Author

Rihari-Thomas J, DiGiacomo M, Phillips J, Newton P, and Davidson PM

Subjects
Adult, Australia, Female, Focus Groups, Hospitals, Teaching, Humans, Inpatients, Male, Attitude of Health Personnel, Critical Care organization & administration, Delivery of Health Care organization & administration, Emergencies, Nurses, Physicians
Abstract

Background: Systemic and structural issues of rapid response system (RRS) models can hinder implementation. This study sought to understand the ways in which acute care clinicians (physicians and nurses) experience and negotiate care for deteriorating patients within the RRS., Methods: Physicians and nurses working within an Australian academic health centre within a jurisdictional-based model of clinical governance participated in focus group interviews. Verbatim transcripts were analysed using thematic content analysis., Results: Thirty-four participants (21 physicians and 13 registered nurses [RNs]) participated in six focus groups over five weeks in 2014. Implementing the RRS in daily practice was a process of informal communication and negotiation in spite of standardised protocols. Themes highlighted several systems or organisational-level barriers to an effective RRS, including (1) responsibility is inversely proportional to clinical experience; (2) actions around system flexibility contribute to deviation from protocol; (3) misdistribution of resources leads to perceptions of inadequate staffing levels inhibiting full optimisation of the RRS; and (4) poor communication and documentation of RRS increases clinician workloads., Conclusion: Implementing a RRS is complex and multifactorial, influenced by various inter- and intra-professional factors, staffing models and organisational culture. The RRS is not a static model; it is both reflexive and iterative, perpetually transforming to meet healthcare consumer and provider demands and local unit contexts and needs. Requiring more than just a strong initial implementation phase, new models of care such as a RRS demand good governance processes, ongoing support and regular evaluation and refinement. Cultural, organizational and professional factors, as well as systems-based processes, require consideration if RRSs are to achieve their intended outcomes in dynamic healthcare settings.

Published
2017
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