How actionable are staff behaviours specified in policy documents? A document analysis of protocols for managing deteriorating patients
Open accessAbstract
BACKGROUND: To optimise care of deteriorating patients, healthcare organisations have implemented rapid response systems including an "afferent" and "efferent" limb. Afferent limb behaviours include monitoring vital signs and escalating care. To strengthen afferent limb behaviour and reduce adverse patient outcomes, the National Early Warning Score was implemented in the UK. There are no published reports of how National Early Warning Score guidance has translated into trust-level deteriorating patient policy and whether these documents provide clear, actionable statements guiding staff. AIM: To identify how deteriorating patient policy documents provide "actionable" behavioural instruction for staff, responsible for actioning the afferent limb of the rapid response system. DESIGN: A structured content analysis of a national guideline and local policies using a behaviour specification framework. METHODS: Local deteriorating patient policies were obtained. Statements of behaviour were extracted from policies; coded using a behaviour specification framework: Target, Action, Context, Timing and Actor and scored for specificity (1 = present, nonspecific; 2 = present, specific). Frequencies and proportions of statements containing elements of the Target, Action, Context, Timing and Actor framework were summarised descriptively. Reporting was guided by the COREQ checklist. RESULTS: There were more statements related to monitoring than escalation behaviour (65% vs 35%). Despite high levels of clear specification of the action (94%) and the target of the behaviour (74%), context, timing and actor were poorly specified (37%, 37% and 33%). CONCLUSION: Delay in escalating deteriorating patients is associated with adverse outcomes. Some delay could be addressed by writing local protocols with greater behavioural specificity, to facilitate actionability. RELEVANCE TO CLINICAL PRACTICE: Numerous clinical staff are required for an effective response to patient deterioration. To mitigate role confusion, local policy writers should provide clear specification of the actor. As the behaviours are time-sensitive, clear specification of the time frame may increase actionability of policy statements for clinical staff.
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- Authors
- Smith, D., Sekhon, M., Francis, J. J., & Aitken, L. M.
- Affiliations
- University of London (GB)
- King's College London (GB)
- Griffith University (AU)
- Corresponding author
- Smith, Duncan
- Venue
- Journal of Clinical Nursing
- Publisher
- Wiley
- Published
- 2019-08-07
- Volume
- 28
- Issue
- 21-22
- Pages
- 4139-4149
- ISSN
- 0962-1067 (ISSN-L)
- 1365-2702
- OpenAlex
- W2963649144
- Cited by
- 29
- References
- 53
- Citations by year
- 2026: 1 · 2025: 8 · 2024: 3 · 2023: 5 · 2022: 6 · 2021: 3 · 2020: 2 · 2019: 1
- FWCI
- 4.40
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- public-domain
- onlinelibrary.wiley.com/termsAndConditions#vor (vor)
- Locations
- Journal of Clinical Nursing (publishedVersion, public-domain)
- PubMed (publishedVersion)
- City Research Online (City University London) (acceptedVersion)
- Research Repository (Kingston University London) (submittedVersion)
- Minerva Access (University of Melbourne) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- Griffith Research Online (submittedVersion)
- Funders
- City, University of London
- Topics
- Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Health Sciences › Medicine › Emergency Medicine › Cardiac Arrest and Resuscitation
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- clinical deterioration, rapid response system, National Early Warning Score, afferent limb, vital signs monitoring, treatment escalation, identity diffusion
- MeSH terms
- Clinical Deterioration, Humans, Time Factors, Practice Guidelines as Topic, Vital Signs, Hospital Rapid Response Team, Policy
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