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Escalation of patient care

Can an interactive training video help clinicians overcome behavioural barriers to the timely escalation of care for deteriorating patients?


Recognising the signs of patient deterioration is a vital clinical skill. The earlier deterioration is recognised, the more that can be done to provide the right care at the right time.


Timely escalation of care can also provide cost savings to the health system by reducing the need for the Medical Emergency Team (MET) to be called in, for example.


Despite being aware of the process and the benefits, healthcare professionals can find it difficult to initiate escalation of care conversations with senior staff due to behavioural barriers like fear of hierarchy, reservations about speaking up and pushback to escalation.


The aim of this trial was to explore the effectiveness of an interactive training video in reducing these barriers.

WHAT DID THE LITERATURE TELL US?

The first phase of this trial involved a Facilitated Dialogue with key stakeholders.


To ensure that participants had a good understanding of the issue – and what others around the world had done to address it – they were briefed with the results of a Rapid Evidence and Practice review (below).

WHAT'S LIKELY TO FIX THE PROBLEM?

From the Facilitated Forum Dialogue, participants drew the following conclusions on how to best approach the issue of patient-clinician communication in the escalation of patient deterioration.

WHAT DID WE DO?

We tested the effectiveness and feasibility of an interactive ‘choose-your-own-adventure’ training video at Austin Health and Eastern Health in Victoria. The video, developed by The Shannon Company, was designed to help clinicians gain experience navigating some of the key behavioural barriers to escalation of care conversations.


Participants were walked through five typical scenarios depicting escalation of care conversations between clinicians in the early stages of patient deterioration.


The five scenarios were associated with key moments for learning and acting, such as:



  1. Obtaining the right information from a range of sources when care may need to be escalated.

  2. Ensuring effective communication of critical information between team members.

  3. Ensuring communication of critical information is clear, concise and structured.

  4. Speaking up and discussing clinical concerns as they arise.

  5. Ensuring that respectful, closed-loop communication always occurs. 

For more information, visit the Trial Registration page on the Australian New Zealand Clinical Trials Registry HERE.

WHAT DID WE FIND?

After viewing the interactive training video, participating clinicians were slightly less reluctant – and more confident – about escalating care.


Small improvements were seen in the number of escalation of care conversations and the number of challenges experienced during these conversations.


However, these improvements did not reach statistical significance. The average number of MET calls made per day for the recruited wards at one site was significantly lower following training.


Clinicians reported that the training video was valuable for learning when and how to escalate care and in taking into account the perspective of other clinicians involved in escalating patient care.

MEDIA AND OTHER INFORMATION

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