Evidence map›Paper›PMID 28114987›Full record

ArticleBMC health services research2017

Study protocol for evaluating the implementation and effectiveness of an emergency department longitudinal patient monitoring system using a mixed-methods approach.

Marie Ward, Eilish McAuliffe, Abel Wakai, Una Geary, John Browne, Conor Deasy, Michael Schull, Fiona Boland, Fiona McDaid, Eoin Coughlan and 1 more

Abstract read
In one paragraph

Article in BMC health services research, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Marie WardSchool of Nursing, Midwifery and Health Systems, College of Health Sciences, University College Dublin, Belfield, Dublin 4, Ireland. M.ward@ucd.ie.ORCID 0000-0002-6638-8461
Eilish McAuliffeSchool of Nursing, Midwifery and Health Systems, College of Health Sciences, University College Dublin, Belfield, Dublin 4, Ireland.
Abel WakaiEmergency Care Research Unit (ECRU), Division of Population Health Sciences (PHS), Royal College of Surgeons in Ireland (RCSI), Dublin 2, Ireland.
Una GearyDepartment of Emergency Medicine, St James's Hospital, Dublin 8, Ireland.
John BrowneDepartment of Epidemiology and Public Health, University College Cork, Western Rd, Cork, Ireland.
Conor DeasyDepartment of Emergency Medicine, Cork University Hospital, Cork, Ireland.
Michael SchullInstitute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
Fiona BolandDivision of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland.
Fiona McDaidDepartment of Emergency Medicine, Naas Hospital, Naas, Co, Kildare, Ireland.
Eoin CoughlanDepartment of Epidemiology and Public Health, University College Cork, Western Rd, Cork, Ireland.
Ronan O'SullivanSchool of Medicine, University College Cork, Western Rd, Cork, Ireland.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundEarly 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).

methodsA 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.

Indexed as

Critical CareCritical IllnessGuideline AdherenceMonitoring, PhysiologicDelivery of Health CareDisease ProgressionEmergency Service, HospitalHealth Services ResearchHumansIrelandLongitudinal StudiesOutcome Assessment, Health CarePatient-Centered CareProgram DevelopmentProgram EvaluationRiskEarly warning scoreEmergency departmentLongitudinal patient monitoringParticipatory ARProcess and outcome evaluationSocio-technical systems

Identifiers

PMID28114987
PMCPMC5260070

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.