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When things go wrong: An exploration of the effectiveness of Te Whatu Ora – Waikato ‘Patient-at- Risk’ service, from the perspective of healthcare professionals

Abstract: Background: Within an acute hospital, critically ill patients are not always located in the intensive care or high dependency unit. Most often, deteriorating patients are managed in the emergency department or wards (Jevon et al., 2012). Signs of decompensation are subtle, but often occur prior to deterioration or an acute event. Therefore, early recognition and timely management improve patient outcomes and reduce admission into critical care services (Jevon et al., 2012). Internationally, acute care teams have been developed to improve patient outcomes through early identification and escalation. The Waikato Hospital Patient-at-Risk (PaR) team is a wraparound service that act as a safety net to support staff during this time. Conflicting evidence is found in the literature that debates the effectiveness of acute care teams, part of this is due to the composition of acute care teams that differ worldwide, and this study sought to explore the value of the Waikato service. Objective: To explore the perceived value of the Waikato Hospital Patient-at-Risk service from the perspectives of those who utilise this service and those who provide the service. Furthermore, the study seeks to identify the characteristics of patients treated by the PaR service. Participants: Interviews were held with a total of 13 participants (Ward Registered Nurses = 7; PaR service Registered Nurses = 5; Medical doctors = 1). Medical notes for 1,212 PaR patients were analysed. Methods: A mixed method research over two phases. Phase one involved matching medical notes with routinely collected hospital data to explore the correlation between PaR patient characteristics and outcomes. Phase two involved 13 semi-structured interviews with staff from the PaR team and in the wards. Findings from phase one, informed the questions in phase two and interviews underwent a thematic analysis employing a general inductive method of inquiry. Results: This study identified that patients who are seen by the Waikato hospital Patient-at-risk service experience greater complexities contributing to increased length- of-stay. In addition, this service contributes to increased feelings of safety for staff. Conclusion: This study identified that there was significant value of the PaR service in relation to teaching and training of junior nurses as well as reassurance of ward staff when patients began to deteriorate.
Type of thesis
The University of Waikato
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