Aims and Objectives. To identify, appraise and synthesise current evidence regarding organisation-wide interprofessional practice issues that facilitate or inhibit effective recognition and response to clinical deterioration, using a theoretical Rapid Response System (RRS) model. Background. Recognition and response to clinical deterioration, in adult general medical-surgical ward patients, is embedded as a routine interprofessional practice in acute healthcare organisations worldwide. The process of care escalation is complex and sometimes involves multiple health professionals from different disciplines with varying levels of expertise. While a theoretical RRS model offers a formalised structured approach to escalate patient care, it is unclear how the implementation of this model, or similar, influences RRS-wide interprofessional practices to effectively recognise and respond to clinical deterioration. Design. An integrative review. Methods. This review was conducted using key words to systematically search four electronic bibliographic databases (PubMed, CINAHL, ProQuest Central, Cochrane Library). Twenty-nine eligible full text papers were identified. Quality appraisal of methods was performed using recommended guidelines. Study findings were narratively coded, themed and conceptualized in the context of an organisation-wide RRS using an interprofessional collaborative practice (ICP) framework. Results. Five main themes aligned with the four ICP competency domains and a learning continuum of professional development: Organisational culture, Role perceptions and professional accountability, Communication of clinical needs, Team-based practices, and Interprofessional learning opportunities in recognising and responding to clinical deterioration. Within these themes three notable interprofessional practice issues were highlighted: professional reporting hierarchies (inhibiting), critical care outreach services (facilitating), and interprofessional relationships (facilitating). Conclusions. A unique approach for exploring organisation-wide interprofessional practice issues has been presented using an ICP framework. Further interpretive organisation-wide research is necessary to develop a more in-depth and meaningful understanding of ICP issues that facilitate or inhibit effective recognition and response to clinical deterioration.
Allen, EmilyElliott, DougJackson, Debra
Faculty of Health and Life Sciences\Department of Nursing
Year of publication: 2017Date of RADAR deposit: 2017-05-10