Research into clinical safety and quality is closely aligned to the work of the Australian Commission on Safety and Quality in Health Care. This inquiry concentrates on safety and quality of health care systems. The end product of the research contributes to the improvements in the quality of health care delivery and patient results. The work aligns with the ten National Safety and Quality Health Service Standards and the development of clinical standards. Additionally, this research priority area focuses on the World Health Organizations High 5s Project, including three main areas of medication accuracy, clinical communication and surgical safety.
The priority research area is currently involved in three Australian Research Council Linkage Grants, which involves strong collaborative partnerships with International, National Reserachers and Health Industry Partners. The focus of these research grants has been improving the health care system and patient outcomes. The grants have attracted research students and currently two PhD candidates are investigating clinical communication and the transitions of care.
Strong international research links have been established and in 2013 the School of Nursing and Midwifery became a foundation member of the International Research Centre for Communication in Healthcare (IRCCH). This centre’s purpose is to build a world-class, collaborative health communication research and training hub where international health professional and communication experts can work together. IRCCH has 40 international leading researchers. Professor Della is an Associate Director of the centre and works closely with researchers from the Hong Kong Poly University, University Technology Sydney and Harvard Medical School.
Future research in the clinical safety and quality area are planned and include the areas of simulation and health literacy. On an international scene the area of clinical governance and clinical indicators for resident safety are being researched in partnership with Aged Care Providers.
The issue: Early recognition and response to patient clinical deterioration improves patient outcomes. Failure to recognise and respond to patient deterioration increases the risk of avoidable adverse events. More recently (through the Australian Safety and Quality Health Service Standards) the involvement of families in recognising and responding to patient deterioration has been emphasised. In the paediatric setting parents are frequently at the child’s bedside and well positioned to notice that their child’s condition is worsening or not improving. This is the premise for parent initiated escalating care of the deteriorating child. Having a process to involve families in the recognising and responding to the deteriorating patient is now a requirement for all Australian hospitals. What is not yet known is how to implement this from the perspective of users: families, patients, healthcare providers and the health service. This integrated knowledge translation project is designed to address this knowledge gap for implementation in the context of a children’s hospital.
What the best approach for a Parent Initiated Response to Escalate Care of the Deteriorating Child at PMH and Perth Children’s Hospital (PCH)?
How will we answer the question?
Using knowledge translation methods we will evaluate the implementation of a parent initiated response to escalate care for the deteriorating child at PMH. We will use interviews and surveys to identify all stakeholders’ attitudes and beliefs about parent activated escalation of care of the deteriorating child. Patient records will audited to examine parent initiated and overall Medical Emergency Team calls and patient outcomes.
We will identify the factors that impact on the PARTNER approach and report back to the stakeholder group to inform the implementation of a process that specifically meets the needs of Princess Margaret Hospital and the Perth Children’s Hospital. The revised Partner approach will be implemented for six months. The project final step will be evaluation consisting of chart audit, interviews and surveys to 1) evaluate what is working or not working with the PARTNER approach 2) identify interventions to strengthen implementation.
Why is this important?
The project outcome will be an evidence-informed process for parent initiation of escalating care of the deteriorating hospitalised child. We will include the views of all stakeholders including parents from culturally and linguistically diverse populations. A sustainable process involving parents as they wish to be involved will strengthen consumer partnerships for Perth Children’s Hospital. It may enhance the early recognition and response to the deteriorating child in hospital. We will be able to fill the gap in knowledge about how parents may wish to be involved and how to successfully implement a sustainable process. Our work will contribute to the broader literature where there is currently little known about this topic despite local, state and national directives to include this approach as a strategy. Feedback to policy makers will enable patient and family preferences to be built into the early recognition and response component of rapid response systems.
Dr Fenella Gill, NHMRC TRIP Fellow, Curtin University and Princess Margaret Hospital for Children
Professor Gavin Leslie, Curtin University
Professor Andrea Marshall, Menzies Research Institute, Griffith University and The Gold Coast University Hospital, Queensland
Hospital staff – doctors, nurses, hospital leaders, Hospital Consumer Advisory Council (parents), Hospital Youth Advisory Council (children)
International Society of Rapid Responses Systems, Australian College of Children and Young People Nurses, Children’s Hospitals of Australasia, Pediatric Intensive Care Nurse International listserv, Australian College of Critical Care Nurses, Australian Institute of Patient & Family Centred Care, Health Consumers Council of WA.