Background
Methods
Methodological approach
PAR Workshop Participants | Delphi Participants |
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The 10 workshop participants included the following: Director Centre for Nurse Education; Assistant Director of Nursing; Consultant in Intensive Care; ED Business Manager; ED Clinical Nurse Manager; ED Clinical Nurse Facilitator; EM Consultant and Clinical Lead for the project; Professor of Health Systems and joint PI on project; Senior Research Fellow in Human Factors; Postdoctoral Researcher | Round 1: 22 nursing staff, 19 medical staff, 5 academics and researchers, 2 managers and 1 Health and Social Care Professional. Round 2: 12 nursing staff, 19 medical staff, 3 academics and researchers, 4 managers and 1 Health and Social Care Professional. Characteristics of Delphi panellists are outlined in Table 2. |
Round One | Round Two | ||
---|---|---|---|
Number invited to participate | 58 | 58 | |
Number of respondents | 49 (84.5%) | 39 (67.2%) | |
Professional background | Nursing | 22 (44.9%) | 12 (30.8%) |
Medical | 19 (38.8%) | 19 (48.7%) | |
Academic /Faculty | 3 (6.1%) | 2 (5.1%) | |
Managers | 2 (4.1%) | 4 (10.3%) | |
Researchers | 2 (4.1%) | 1 (2.6%) | |
Health and Social Care Professionals | 1 (2.0%) | 1 (2.6%) | |
Currently working in an ED | Yes | 38 (77.5%) | 31 (79.5%) |
Based at hospital where ED-ACE implementation study being conducted | Yes | 17 (34.7%) | 16 (41.0%) |
Data and statistical analysis
Results
Stage one (workshop)
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Treatment process measures examining the treatment process of patients in the ED and how that might be affected by ED-ACE.
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Implementation process measures exploring the implementation, receipt and setting of implementing ED-ACE and help in the interpretation of the outcome results.
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Outcome Measures to determine if ED-ACE results in an improvement in patient outcomes.
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Balancing measures exploring the use of ED-ACE from different dimensions and the possible impact of its use on other areas of the ED and the wider hospital system.
Stage two (Delphi consensus process)
Characteristics of the panel
Stability of items ranked in both rounds
Variable domain | Round One | Round Two | p-value | ||||
---|---|---|---|---|---|---|---|
No of respondents | Variable | No (%) panellists ranking variable Important/ Very important | No of respondents | Variable | No (%) panellists ranking variable Important/ Very important | ||
Treatment | 39 | Time of completion of admitting/consulting team assessment to time of ED departure | 26 (66.7%) | 35 | Time of completion of admitting/consulting team assessment in the ED to time of ED departure | 25 (71.4%) | 0.66 |
Treatment | 39 | ICU admission rate | 22 (56.4%) | 35 | ICU admission rate | 30 (85.7%) | 0.01 |
Implementation | 35 | ICU referral rate | 23 (65.7%) | 32 | ICU referral rate | 25 (78.1%) | 0.78 |
Implementation | 35 | Resuscitation room activity level | 22 (62.9%) | 32 | Resuscitation room activity level | 30 (93.8%) | 0.01 |
Implementation | 35 | Number of times ISBAR communication tool was used to communicate the need for escalation | 22 (62.9%) | 32 | Number of times ISBAR communication tool was used to communicate the need for escalation | 25 (78.1%) | 0.52 |
Implementation | 35 | Health Professionals Work Index (HPWI) survey to measure autonomy and control over practice; work place relationships; managerial support and availability of resources | 20 (57.1%) | 32 |
Staff perception of availability of support and resources
| 27 (84.4%) | 0.04 |
Implementation | 35 | Number of people being triaged | 18 (51.4%) | 32 | Number of patients triaged | 27 (84.4%) | 0.01 |
Implementation | 35 | Minnesota Job Satisfaction Questionnaire to measure job satisfaction | 16 (45.7%) | 32 |
Job satisfaction for ED staff
| 30 (93.8%) | < 0.001 |
Treatment (Round 1) /utcome (Round 2) | 39 | Admission to Intensive Care Unit (ICU) within 2 days of having been assessed and treated and deemed appropriate for admission to a hospital ward from ED | 25 (64.1%) | 31 | Admission to Intensive Care Unit (ICU) within 2 h of having been assessed and treated and deemed appropriate for admission to the ICU from the ED | 22 (71.0%) | 0.55 |
Outcome | 34 | In-hospital mortality rate | 23 (67.6%) | 31 | In-hospital mortality rate | 24 (77.4%) | 0.38 |
Balancing | 32 | Service delivery measured through e.g. resources (beds, equipment etc.) against recommended requirements | 22 (68.8%) | 30 | Service delivery measured through e.g. available resources (beds, equipment etc.) against recommended requirements | 23 (76.7%) | 0.72 |
Balancing | 32 | Average length of stay (AVLOS) in hospital for patients who come through ED | 22 (68.8%) | 30 | Average length of stay (AVLOS) in hospital for patients who come through ED | 23 (76.7%) | 0.72 |
Balancing | 32 | Number of patients waiting for in-patient beds | 21 (65.6%) | 30 | Number of patients who are in the ED waiting for in-patient beds | 24 (80.0%) | 0.30 |
ED-ACE evaluation measures
IHI Category | Highest Mean Rated Variable | Mean Rating (95% CI) |
---|---|---|
(A) Treatment Process Measures | Early detection and treatment of patients at risk of sepsis | 4.95 [4.82, 4.97] |
Early identification and treatment of life-threatening complications | 4.90 [4.82, 5.00] | |
Early detection and treatment of patients with chest pain at risk of myocardial infarction | 4.85 [4.74, 4.95] | |
(B) Implementation Process Measures | Number of patients who deteriorated as identified by ED-ACE | 4.63 [4.43, 4.77] |
Number of patients whose care was escalated as a result of using ED-ACE | 4.54 [4.20, 4.74] | |
Number of re-triages that took place as a result of using D-ACE | 4.31 [4.08, 4.49] | |
(C) Outcome Measures | Reduction in the number of serious incidents in the ED | 4.59 [4.33, 4.77] |
Reduction in the number of unexpected deaths in the ED | 4.41 [4.24. 4.62] | |
Prevalence of deterioration in ED patients | 4.38 [4.06, 4.68] | |
(D) Balancing Measures | Number of patients who are in the ED waiting for in-patient beds | 4.33 [3.98, 4.63] |
Service delivery measured through actual staffing levels against recommended staffing levels | 4.25 [3.97, 4.53] | |
Staff adherence to treatment guidelines (e.g. treatment guidelines for acute stroke and acute myocardial infarction) | 4.19 [3.88, 4.53] |