The Role of Patients and Families in Managing Patient Deterioration Lead: Dr Abi Albutt (PhD Project) Supervisors: Prof Mark Conner, Prof Rebecca Lawton Measures exist to improve early recognition of, and response to
deteriorating patients in hospital. Yet, 11% of deaths in UK hospitals in 2005
were the result of patient deterioration going unrecognised or not being acted
on (NPSA, 2007). The thesis aimed to investigate whether patients and relatives
can aid health professionals in recognising clinical deterioration. A
systematic review was conducted which identified interventions that allow
patients and relatives to escalate patient deterioration. However, there is not
strong evidence for the clinical effectiveness of these interventions, and a
limited understanding of patient and relative ability to recognise patient
deterioration. In study 1, health professionals generated potentially feasible
and acceptable methods of involving patients and/or relatives in recognising
deterioration in hospital. Recording patients’ views on changes in their
wellness during routine observation was proposed. Focus groups were held in
study 2 with healthcare assistants and patients to develop a questionnaire to
capture patients’ and relatives’ ratings of patient wellness. Study 3 piloted
approaches to routinely collecting patient wellness ratings using the
questionnaire on in-patient wards. Where the researcher attended observation to
record patients’ ratings, this was acceptable to most patients. However, there
was limited uptake where patients and relatives were invited to complete the
questionnaire themselves, and staff were invited to record patients’ wellness
ratings during observation. It may be necessary to encourage and support staff
to adopt this change in practice. In study 4, the use of behaviour change
techniques to encourage staff to routinely record patient-reported wellness in
practice were effective on wards showing high previous levels of engagement
with the observation system. The clinical effectiveness of routinely recording
patient-reported wellness was also explored. Significant associations between
patient-reported wellness, and early warning score and vital sign measurements
were found, and these were stronger in more acutely unwell patients. Evidence
from the thesis suggests that routinely recording patient-reported wellness may
be one feasible strategy that could aid health professionals in the early
recognition of clinical deterioration. Publications |
Contact | Dr Abi Albutt or
Professor Rebecca Lawton | r.j.lawton@leeds.ac.uk