Study prioritises nurses’ responses to critically ill patients

Improving Health and Wellbeing

A new study is looking at ways to improve the recognition of critically ill hospital patients, and ultimately save lives.

Led by Professor Tracey Bucknall from Deakin University’s Centre for Quality and Patient Safety Research, a major partnership study is investigating ways to improve first line management of patient deterioration in hospitals.

The study is focusing on the identification of at-risk patients in the first hours, to minutes, before critical events.

“The identification of abnormal vital signs is paramount to ensuring patient safety and care,” said Professor Bucknall, Associate Head of Research at Deakin’s School of Nursing and Midwifery and member of the research centre.

“If signs of deterioration are missed, misinterpreted, or mismanaged, then critical illness, cardiac arrest, intensive care unit admissions, and even death may result.

“Despite a growing body of evidence that shows the benefit of early recognition and management of patients, there is a gap between what the research is telling us that we need to do and what happens in the clinical setting. With this study we are looking at ways to close this gap.”
Professor Tracey Bucknall
Professor Tracey Bucknall Centre for Quality and Patient Safety Research

Through the “Prioritising Responses of Nurses to Deteriorating Patient Observations” (PRONTO) study, the researchers will conduct a randomised trial in four Victorian hospitals, with the goal of improving the uptake of clinical practice guidelines for identifying and managing deteriorating patients in hospitals.

The PRONTO study will use a facilitated implementation approach, tailored to a local ward context to improve patient care. Nurses will be offered support throughout the process and any barriers to improving patient safety and clinical practice will be addressed.

“Evidence suggests that practice changes can be made successfully when a facilitated implementation approach is used,” Professor Bucknall said.

The Australian Commission on Safety and Quality in Health Care (ACSQHC) is taking part in the research. It has responsibility for the National Safety and Quality Health Service Standards, which address the need for hospitals to have systems in place for recognising and responding to clinical deterioration. In particular, Standard nine concerns “Recognising and Responding to Clinical Deterioration in Acute Health Care.”

“The intention of the Standard nine is to ensure that a patient’s deterioration is recognised promptly and appropriate action is taken,” said ACSQHC’s Clinical Director, Dr Robert Herkes.

“Advancements in health care mean there are many tools available to assess patient responses to illness and treatment, but measuring patients’ vital signs remains the most common technique used.”

The PRONTO study has been funded through the National Health and Medical Research Council’s Partnership Project Scheme and involves researchers from: Deakin’s Centre for Quality and Patient Safety Research; the University of Adelaide; Australian National University; Bangor University (UK); and the University of Ottawa, Canada.

Partners in the project are: Alfred Health; Monash Health; Eastern Health – Victoria; The Australian Commission on Safety and Quality in Health Care; and SA Health.

Centre for Quality and Patient Safety Research

The Centre for Quality and Patient Safety Research (QPS) strives to improve health and wellbeing through the development of a strong interface between research, education and practice and progressive innovations in research and teaching for improving patient safety and health care outcomes.