Involving patients in recognising clinical deterioration in hospital

 

Research team: Dr Abigail Albutt, Dr Gemma Louch, Dr Ali Cracknell, Professor Rebecca Lawton, Professor Mark Conner, Dr Jane O’Hara, Dr Damian Roland

Collaborations

Leeds Teaching Hospitals NHS Trust

CLAHRC East Midlands and Leicester Royal Infirmary as part of a 2019 NIHR SPARC award titled ‘Exploration and comparison of the adapted Patient Wellness Questionnaire for paediatrics and the Paediatric Observation Priority Score (POPS)’

Why is this project important?

It is increasingly recognised that patients can make important contributions towards their safety whilst in hospital. There have been a number of initiatives to encourage patient involvement in patient safety. One area of patient safety that might benefit from the involvement of patients is improving the early detection of clinical deterioration in hospital. Although measures exist to improve early recognition and response to patient deterioration such as National Early Warning Scores (NEWS) and Critical Care Outreach Teams, some deteriorating patients can still to go unrecognised and timely action is not always taken. It’s intuitive to think that patients and their relatives have knowledge of the patient and their norms, and may sense if the patient’s clinical condition is worsening but there is a lack of empirical evidence investigating this topic.

What are we doing?

As part of a PhD project (2014-2018), Dr. Abigail Albutt explored whether routinely recording patients’ views on their wellness during observation was feasible, acceptable and potentially clinically effective.

This preliminary evidence suggests that patient-reported wellness may be a precursor for subsequent improvement or decline in their condition as indicated by objective measurements of their health. Our project follows on from this work and aims to explore on a larger scale, whether patient-reported wellness can help predict outcomes such as cardiac arrest, unexpected transfer to Intensive Care and mortality.

We are excited to be working with a local trust to implement routine recording of patient-reported wellness using the Patient Wellness Questionnaire during observation on in-patient wards as part of routine care. We will also speak with healthcare staff working on the sampled wards to understand their experiences of using the Patient Wellness Questionnaire during routine observation. This study will help us understand whether asking patients routinely about their wellness during observation is effective at improving early detection of clinical deterioration.

Alongside this work with adult populations, we are working with Dr Damian Roland on a study exploring the validity of using the adapted Patient Wellness Questionnaire for Paediatrics in practice. This work is being conducted as part of an NIHR funded Short Placement Award for Research Collaboration.

Patient and Public Involvement and Engagement

Abi has sought guidance from paediatric health professionals and parents of children under 18 years to support the development of the Patient Wellness Questionnaire for Paediatrics. Our Lay Leader has also given advice about building PPIE opportunities throughout the projects with adults and child populations.

Outputs and Impact                                                                                              

  • Poster presentation: International Conference on Rapid Response Systems and Medical Emergency Teams, Manchester – July 2018
  • Breakout session at Implementing NEWS 2 in Yorkshire & Humber Acute Trusts event, Leeds – October 2018
  • Oral presentation: Improving patient safety: New horizons, new perspectives, Leeds – October 2019
  • NIHR funded Short Placement Award for Research Collaboration, Leicester Royal Infirmary Paediatric Accident and Emergency – November 2019
  • Albutt A, O’Hara J, Conner M, Lawton R. Involving patients in recognising clinical deterioration in hospital using the Patient Wellness Questionnaire: A mixed-methods study. Journal of Research in Nursing. 2019 Sep 25:1744987119867744.

Contact for more information: Dr Abigail Albutt