School of Nursing and Midwifery & Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, Vic. 3220, Australia.
Department of Intensive Care, Austin Hospital, 145 Studley Road, Heidelberg, Vic. 3084, Australia; and School of Public Health and Preventive Medicine, Monash University, 533 St Kilda Road, Melbourne, Vic. 3004, Australia; and Department of Surgery, University of Melbourne, Parkville, Vic. 3010, Australia.
Aust Health Rev. 2023 Aug;47(4):494-501. doi: 10.1071/AH22203.
Objective To explore clinicians' use and perceptions of interdisciplinary communication pathways for escalating care within the pre-medical emergency team (pre-MET) tier of rapid response systems. Method A sequential mixed-methods study was conducted using observations and interviews. Participants were clinicians (nurses, allied health, doctors) caring for orthopaedic and general medicine patients at one hospital. Descriptive and thematic analyses were conducted. Results Escalation practices were observed for 13 of 27 pre-MET events. Leading communication methods for escalating pre-MET events were alphanumeric pagers (61.5%) and in-person discussions (30.8%). Seven escalated pre-MET events led to bedside pre-MET reviews by doctors. Clinician interviews (n = 29) culminated in two themes: challenges in escalation of care, and navigating information gaps. Clinicians reported deficiencies in communication methods for escalating care that hindered interdisciplinary communication and clinical decision-making pertaining to pre-MET deterioration. Conclusion Policy-defined escalation pathways were inconsistently utilised for pre-MET deterioration. Available communication methods for escalating pre-MET events inadequately fulfilled clinicians' needs. Variable perceptions of escalation pathways illuminated a lack of of a shared mental model about clinicians' roles and responsibilities. To optimise timely and appropriate management of patient deterioration, communication infrastructure and interdisciplinary collaboration must be enhanced.
探讨临床医生在医疗急救团队（MET）前级快速反应系统中使用和感知跨学科沟通途径来升级护理的情况。
采用观察和访谈的顺序混合方法研究，参与者为一家医院照顾骨科和普通内科患者的临床医生（护士、辅助医疗人员、医生）。进行了描述性和主题分析。
在 27 次 MET 前事件中观察到了 13 次升级实践。升级 MET 前事件的主要沟通方法是数字寻呼机（61.5%）和面对面讨论（30.8%）。7 次升级的 MET 前事件导致医生在床边进行 MET 前审查。临床医生访谈（n=29）最终得出两个主题：护理升级的挑战，以及解决信息差距。临床医生报告说，用于升级护理的沟通方法存在缺陷，这阻碍了跨学科沟通和与 MET 恶化相关的临床决策。
政策定义的升级途径在 MET 恶化时并未得到一致使用。用于升级 MET 事件的现有沟通方法不能满足临床医生的需求。对升级途径的不同看法表明，临床医生的角色和责任缺乏共同的心理模型。为了优化患者恶化的及时和适当管理，必须增强沟通基础设施和跨学科协作。
