Abstract
Background
The acute derangement of physiological function is a time-critical medical emergency
requiring prompt recognition. As autonomous practitioners in resource scarce, high-risk
environments, clinical deterioration can impose complex and increased clinical demands
on paramedics. Early recognition is imperative to facilitating proactive responses
to mitigate adverse effects. This study aimed to determine if clinicians can meet
consensus regarding meaningful clinical factors for recognising to out-of-hospital
(OOH) clinical deterioration risk.
Methods
A three-round electronic Delphi study was conducted between June 2020 and January
2021. The expert panel was composed of 30 clinicians, including paramedics and emergency
physicians. Participants were presented with eight clinically diverse case vignettes
addressing various clinical factors related to OOH clinical deterioration.
Results
Participants identified various challenges related to the recognition of OOH clinical
deterioration. Although participants were able to meet consensus on most clinical
factors related to deterioration, consensus was not achieved where cases had a combination
of factors including: medical aetiology, subtle vital sign changes, non-specific complaints,
age-extreme patients, and presence of co-morbidities.
Conclusions
This study demonstrated that clinicians face various challenges to recognising clinical
deterioration in the OOH setting. Better understanding these challenging patient cohorts
could assist to increase awareness and improve early recognition of OOH clinical deterioration.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Australasian Emergency CareAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Association between clinically abnormal observations and subsequent in-hospital mortality: a prospective study.Resuscitation. 2004; 62: 137-141https://doi.org/10.1016/j.resuscitation.2004.03.005
- Repeated vital sign measurements in the emergency department predict patient deterioration within 72 h: a prospective observational study.Scand J Trauma Resusc Emerg Med. 2018; 26https://doi.org/10.1186/s13049-018-0525-y
- Physiological status during emergency department care: relationship with inhospital death after clinical deterioration.Crit Care Resusc. 2015; 17: 257-262
- Clinical deterioration: a concept analysis.J Clin Nurs. 2018; 27: 1360-1368
- Paramedics and scope of practice.Med J Aust. 2015; 203: 240-241https://doi.org/10.5694/mja15.00775
- The value of vital sign trends in predicting and monitoring clinical deterioration: a systematic review.PLoS One. 2019; 14https://doi.org/10.1371/journal.pone.0210875
- Duration of life-threatening antecedents prior to intensive care admission.Intensive Care Med. 2002; 28: 1629-1634https://doi.org/10.1007/s00134-002-1496-y
- A comparison of antecedents to cardiac arrests, deaths and emergency intensive care admissions in Australia and New Zealand, and the United Kingdom--the ACADEMIA study.Resuscitation. 2004; 62: 275-282https://doi.org/10.1016/j.resuscitation.2004.05.016
- The mortality associated with review by the rapid response team for non-arrest deterioration: a cohort study of acute hospital adult patients.Crit Care Resusc. 2014; 16: 119-126
- Improving detection of patient deterioration in the general hospital ward environment.Eur J Anaesthesiol. 2018; 35: 325-333
- Why do healthcare professionals fail to escalate as per the early warning system (EWS) protocol? A qualitative evidence synthesis of the barriers and facilitators of escalation.BMC Emerg Med. 2021; 21https://doi.org/10.1186/s12873-021-00403-9
- Defining and recognising clinical deterioration in the prehospital setting (PRECLuDE study): a systematic scoping review.Ir J Paramed. 2020; 5https://doi.org/10.32378/ijp.v5i1.245
- Research guidelines for the Delphi survey technique.J Adv Nurs. 2000; 32: 1008-1015
- The Delphi technique: making sense of consensus.Pract Assess Res Eval. 2007; 12: 1-10
- The Delphi method.Acad Med. 2020; 95: 168
- Consulting the oracle: ten lessons from using the Delphi technique in nursing research.J Adv Nurs. 2005; 53: 205-212
- Using an e-Delphi technique in achieving consensus across disciplines for developing best practice in day surgery in Ireland.J Hosp Adm. 2014; 3: 1-8
- Applying the Delphi technique in a study of GP’s information requirements.Health Soc Care Community. 1998; 7: 198-205
Rodríguez-Mañas L., Féart C., Mann G., Viña J., Chatterji S., Chodzko-Zajko W., et al. Searching for an operational definition of frailty: a delphi method based consensus statement. The frailty operative definition-consensus conference project. J Gerontol, 68(1); 2013. p. 62–7.
- Consensus on paramedic clinical decisions during high-acuity emergency calls: results of a Canadian Delphi study.CJEM. 2011; 13: 310-318
- The impact of “No opinion” response options on data quality: non-attitude reduction or an invitation to satisfice?.Public Opin Q. 2002; 66: 371-403
- One size doesn’t fit all: selecting response scales for attitude items.J Elect Public Opin Parties. 2005; 15: 237-264
- An exploration of the use of simple statistics to measure consensus and stability in Delphi studies.BMC Med Res Methodol. 2007; 7: 1-10https://doi.org/10.1186/1471-2288-7-52
- Predictive scoring in non-trauma emergency patients: a scoping review.Emerg Med J. 2011; 28: 827-837
- Ambulance alerting to hospital: the need for clearer guidance.Emerg Med J. 2006; 23: 811-814
- Prognosis and risk factors for deterioration in patients admitted to a medical emergency department.PLoS One. 2014; 9e94649https://doi.org/10.1371/journal.pone.0094649
- Elderly emergency patients presenting with non-specific complaints: characteristics and outcomes.PLoS One. 2017; 12e0188954https://doi.org/10.1371/journal.pone.0188954
- Factors associated with emergency medical service reattendance in low acuity patients not transported by ambulance.Prehosp Emerg Care. 2021; 26: 66-77https://doi.org/10.1080/10903127.2020.1862943
- Paramedics’ perspectives on factors impacting on-scene times for trauma calls.Prehosp Disaster Med. 2018; 33: 250-255
- Factors influencing on-scene time in a rural Norwegian helicopter emergency medical service: a retrospective observational study.Scand J Trauma Resusc Emerg Med. 2017; 25: 97https://doi.org/10.1186/s13049-017-0442-5
- A comparison of Australasian jurisdictional ambulance services’ clinical practice guidelines series: an introduction.Australas J Paramed. 2021; : 18https://doi.org/10.33151/ajp.18.914
- The use of early warning system scores in prehospital and emergency department settings to predict clinical deterioration: a systematic review and meta-analysis.PLoS One. 2022; 17e0265559https://doi.org/10.1371/journal.pone.0265559
- Delayed rapid response team activation is associated with increased hospital mortality, morbidity, and length of stay in a tertiary care institution.Crit Care Med. 2016; 44: 54-63
- The Delphi technique: a case study.Phi Delta Kappan. 1971; 52: 272-273
Article info
Publication history
Published online: July 15, 2022
Accepted:
July 3,
2022
Received in revised form:
July 1,
2022
Received:
June 2,
2022
Identification
Copyright
© 2022 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.
