You're Worried, We're Listening: Online Testing of the Effectiveness of Education Materials to Improve Consumer Knowledge and Confidence in Reporting Patient Deterioration

A cross-sectional survey analysis of patient and family knowledge, confidence, and perceived barriers to reporting patient deterioration

BACKGROUND

The knowledge, confidence, and skills of healthcare consumers to identify acute clinical deterioration and appropriately escalate concerns remain largely undetermined. This gap is despite the widespread international introduction of consumer escalation systems intended to provide patients and family an avenue to escalate their concerns if worried about deterioration in their own or relative's condition during a hospital stay.

AIM

To explore patient and family knowledge of acute clinical deterioration, and their confidence and perceived barriers to escalating their concerns.

DESIGN

Cross-sectional, in-person, consumer surveys across an Australian acute adult hospital. The study specific survey tool was developed through a multistage process with healthcare consumer input during creation and testing.

METHODS

Questions explored healthcare consumer knowledge, confidence, and perceived barriers in association with acute clinical deterioration, recognising deterioration, and escalating concerns. Descriptive and inferential analysis was completed, and knowledge, confidence, and barrier scores established. Association between scores and consumer type, gender, age, education level, prior experience with clinical deterioration or rapid response team review, and hospitalisation history in the last 12 months were assessed using multivariable linear regression.

RESULTS

133 surveys were completed. Knowledge scores varied across respondents. Awareness of the local consumer escalation system was low. A positive association was identified between knowledge and confidence that diminished with increasing barrier scores. A strong negative correlation was present between barriers and confidence. No significant difference existed in knowledge, confidence, or barrier scores based on consumer type, gender, education level, previous experience with deterioration or rapid response team review, or hospitalisation history.

CONCLUSIONS

Limitations in patient and family knowledge may impede consumer escalation system success. Increasing knowledge may enhance patient and family confidence to identify deterioration and escalate concerns. However, barriers to consumer escalation decrease this potential. Interventions to increase consumer knowledge should therefore be accompanied by strategies to minimise barriers.

Opinions of Nurses and Physicians on a Patient, Family, and Visitor Activated Rapid Response System in Use Across Two Hospital Settings

BACKGROUND

Early detection of deterioration of hospitalized patients with timely intervention improves outcomes in the hospital. Patients, family members, and visitors (consumers) at the patient's bedside who are familiar with the patient's condition may play a critical role in detecting early patient deterioration. The authors sought to understand clinicians' views on consumer reporting of patient deterioration through an established hospital consumer-initiated escalation-of-care system.

METHODS

A convenience sample of new graduate-level to senior-level nurses and physicians from two hospitals in South Australia was administered a paper survey containing six open-ended questions. Data were analyzed with a matrix-style framework and six steps of thematic analysis.

RESULTS

A total of 244 clinicians-198 nurses and 46 physicians-provided their views on the consumer-initiated escalation-of-care system. Six major themes and subthemes emerged from the responses indicating that (1) clinicians were supportive of consumer reporting and felt that consumers were ideally positioned to recognize deterioration early and raise concerns about it; (2) management support was required for consumer escalation processes to be effective; (3) clinicians' workload could possibly increase or decrease from consumer escalation; (4) education of consumers and staff on escalation protocol is a requirement for success; (5) there is need to build consumer confidence to speak up; and (6) there is a need to address barriers to consumer escalation.

CONCLUSION

Clinicians were supportive of consumers acting as first reporters of patient deterioration. Use of interactive, encouraging communication skills with consumers was recognized as critical. Annual updating of clinicians on consumer reporting of deterioration was also recommended.

Hospital Testing of the Effectiveness of Co-Designed Educational Materials to Improve Patient and Visitor Knowledge and Confidence in Reporting Patient Deterioration

BACKGROUND

Co-designed educational materials could significantly improve the likelihood of patients and visitors (consumers) escalating care through hospital systems. The objective was to investigate patients' and visitors' knowledge and confidence in recognizing and reporting patient deterioration in hospitals before and after exposure to educational materials.

METHODS

A multimethod design involved a convenience sample of patients and visitors at a South Australian hospital. Knowledge and confidence of participants to report patient deterioration was assessed using a validated questionnaire. Baseline group was surveyed, and a second group was surveyed after exposure to a poster and on-hold message relating to consumer-initiated escalation-of-care. Nominal data were examined using chi-square analysis, and ordinal data using the Mann-Whitney U test. Open-ended questions were examined using thematic analysis.

RESULTS

A total of 407 participants completed the study, 203 undertook the baseline survey, and 204 the postintervention survey. Respondents exposed to the educational materials reported significantly higher recognition of responsibility to report concerns about patient deterioration compared to controls (86.3% vs. 73.1%; p = 0.007). Respondents exposed to the educational materials also had better ability to identify signs that a patient was becoming sicker compared to controls (77.5% vs. 71.3%, p = 0.012). Four overarching themes emerged from the questions: patient/visitor understanding of key messages, patient/visitor recognition of deterioration, patient/visitor response to deterioration and patient/visitor recommendations.

CONCLUSION

Following educational interventions, patients and visitors report improved awareness of their role in recognizing and responding to clinical deterioration. They advise additional active interventions and caution that the materials should accommodate language, cultural, and disability needs.