Matthew Hacker Teper1, Nikki Naghavi2, Laura Pozzobon3, Daniel Lee4, Camilla Parpia4, Ahmed Taher5,6. 1. Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada. Matthew.HackerTeper@mail.utoronto.ca. 2. School of Medicine, Ross University, Bridgetown, Barbados. 3. Quality, Safety and Clinical Adoption, University Health Network, Toronto, ON, Canada. 4. Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada. 5. Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada. 6. Emergency Department, University Health Network, Toronto, ON, Canada.
Abstract
INTRODUCTION: Escalation of care is the timely recognition and communication of deterioration in a previously stable patient. Delays in escalating care may lead to unnecessary patient morbidity and mortality. There is currently a paucity of synthesis of work focused on the initiation of escalation of care in the emergency department (ED), where unique challenges may be present. We sought to complete a scoping review to investigate: (1) factors (barriers and/or facilitators) affecting clinicians in escalating care in the ED; and (2) tools that support clinicians in ED escalation of care processes. METHODS: We conducted a scoping review guided by the Arksey & O'Malley framework, and in accordance with PRISMA Scoping Reviews (PRISMA-ScR) checklist. Searches were conducted in MEDLINE, EMBASE and CINAHL on November 30th, 2020. Extracted data was analyzed via qualitative content analysis. Review and data abstraction were completed by two independent reviewers. Discrepancies were resolved via consensus meetings with a third reviewer. RESULTS: Of the 4527 unique records identified, 13 studies met our inclusion criteria. Studies described standard escalation practices including detection, reporting, and response. Factors influencing escalation of care were described on individual (confidence, comfort, and expertise), interpersonal (communication and the nurse-physician relationship), organizational (workload and staffing), and environmental (distractions and layout) levels. Four ED-specific tools for escalation of care were also identified. CONCLUSION: This scoping review identified 13 studies that contained information on processes, factors influencing and/or tools used to facilitate escalation of care in the ED. They may serve as valuable starting points for ED clinicians and administrators who are building or reforming local escalation of care processes.
INTRODUCTION: Escalation of care is the timely recognition and communication of deterioration in a previously stable patient. Delays in escalating care may lead to unnecessary patient morbidity and mortality. There is currently a paucity of synthesis of work focused on the initiation of escalation of care in the emergency department (ED), where unique challenges may be present. We sought to complete a scoping review to investigate: (1) factors (barriers and/or facilitators) affecting clinicians in escalating care in the ED; and (2) tools that support clinicians in ED escalation of care processes. METHODS: We conducted a scoping review guided by the Arksey & O'Malley framework, and in accordance with PRISMA Scoping Reviews (PRISMA-ScR) checklist. Searches were conducted in MEDLINE, EMBASE and CINAHL on November 30th, 2020. Extracted data was analyzed via qualitative content analysis. Review and data abstraction were completed by two independent reviewers. Discrepancies were resolved via consensus meetings with a third reviewer. RESULTS: Of the 4527 unique records identified, 13 studies met our inclusion criteria. Studies described standard escalation practices including detection, reporting, and response. Factors influencing escalation of care were described on individual (confidence, comfort, and expertise), interpersonal (communication and the nurse-physician relationship), organizational (workload and staffing), and environmental (distractions and layout) levels. Four ED-specific tools for escalation of care were also identified. CONCLUSION: This scoping review identified 13 studies that contained information on processes, factors influencing and/or tools used to facilitate escalation of care in the ED. They may serve as valuable starting points for ED clinicians and administrators who are building or reforming local escalation of care processes.
Authors: Ken M Hillman; Peter J Bristow; Tien Chey; Kathy Daffurn; Theresa Jacques; Sandra L Norman; Gillian F Bishop; Grant Simmons Journal: Intensive Care Med Date: 2002-09-11 Impact factor: 17.440
Authors: N Alam; I L Vegting; E Houben; B van Berkel; L Vaughan; M H H Kramer; P W B Nanayakkara Journal: Resuscitation Date: 2015-03-06 Impact factor: 5.262
Authors: Christopher B Sankey; Gail McAvay; Jonathan M Siner; Carol L Barsky; Sarwat I Chaudhry Journal: J Gen Intern Med Date: 2016-03-11 Impact factor: 5.128
Authors: Maximilian J Johnston; Sonal Arora; Dominic King; George Bouras; Alex M Almoudaris; Rachel Davis; Ara Darzi Journal: Surgery Date: 2015-04 Impact factor: 3.982
Authors: Alasdair R Corfield; Fiona Lees; Ian Zealley; Gordon Houston; Sarah Dickie; Kirsty Ward; Crawford McGuffie Journal: Emerg Med J Date: 2013-03-09 Impact factor: 2.740