دانلود رایگان مقاله انگلیسی پروتکل مطالعه برای ارزیابی اجرای و اثربخشی سیستم مانیتورینگ بیمار در اورژانس - اشپرینگر 2017

Abstract

Background: Early detection of patient deterioration is a key element of patient safety as it allows timely clinical intervention and potential rescue, thus reducing the risks of serious patient safety incidents. Longitudinal patient monitoring systems have been widely recommended for use to detect clinical deterioration. However, there is conflicting evidence on whether they improve patient outcomes. This may in part be related to variation in the rigour with which they are implemented and evaluated. This study aims to evaluate the implementation and effectiveness of a longitudinal patient monitoring system designed for adult patients in the unique environment of the Emergency Department (ED). Methods: A novel participatory action research (PAR) approach is taken where socio-technical systems (STS) theory and analysis informs the implementation through the improvement methodology of ‘Plan Do Study Act’ (PDSA) cycles. We hypothesise that conducting an STS analysis of the ED before beginning the PDSA cycles will provide for a much richer understanding of the current situation and possible challenges to implementing the ED-specific longitudinal patient monitoring system. This methodology will enable both a process and an outcome evaluation of implementing the ED-specific longitudinal patient monitoring system. Process evaluations can help distinguish between interventions that have inherent faults and those that are badly executed. Discussion: Over 1.2 million patients attend EDs annually in Ireland; the successful implementation of an ED-specific longitudinal patient monitoring system has the potential to affect the care of a significant number of such patients. To the best of our knowledge, this is the first study combining PAR, STS and multiple PDSA cycles to evaluate the implementation of an ED-specific longitudinal patient monitoring system and to determine (through process and outcome evaluation) whether this system can significantly improve patient outcomes by early detection and appropriate intervention for patients at risk of clinical deterioration.

Discussion

The position of the ED at the boundary between the hospital and its local population places it at the crossroads of multiple systems of care. In Ireland there are over 1.2 million annual ED attendances. Access blockages and long wait times in many EDs lead to ED crowding. This poses a risk to patient safety because deteriorating patients may go undetected during their prolonged stay in crowded EDs and are therefore at risk of developing serious adverse outcomes. Successful implementation of this new ED longitudinal patient monitoring system therefore has the potential of improving the quality of ED care and safety of a significant number of patients in the healthcare system. The ED longitudinal patient monitoring system being investigated aims to minimise clinical risk for ED patients through timely reassessment and appropriate clinical escalation for the duration of their ED-based care.

To determine the effectiveness of the implementation of ED-ACE, a novel mixed-methods approach is employed to evaluating its implementation, which to the best of our knowledge is the first study combining STS and PAR with multiple PDSA cycles. There are however a number of limitations that we are aware of.