Study protocol for evaluating the implementation and effectiveness of an emergency department longitudinal patient monitoring system using a mixed-methods approach

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dc.contributor.authorWard, Marie
dc.contributor.authorMcAuliffe, Eilish
dc.contributor.authorWakai, Abel
dc.contributor.authorGeary, Una
dc.contributor.authorBrowne, John P.
dc.contributor.authorDeasy, Conor
dc.contributor.authorSchull, Michael
dc.contributor.authorBoland, Fiona
dc.contributor.authorMcDaid, Fiona
dc.contributor.authorCoughlan, Eoin
dc.contributor.authorO'Sullivan, Ronan
dc.contributor.funderHealth Research Boarden
dc.contributor.funderHealth Service Executive, Irelanden
dc.contributor.funderRoyal College of Physicians, Irelanden
dc.contributor.funderRoyal College of Physicians, Irelanden
dc.date.accessioned2017-01-30T15:36:31Z
dc.date.available2017-01-30T15:36:31Z
dc.date.issued2017-01-23
dc.description.abstractBackground: Early detection of patient deterioration is a key element of patient safety as it allows timely clinical intervention and potential rescue, thus reducing the risks of serious patient safety incidents. Longitudinal patient monitoring systems have been widely recommended for use to detect clinical deterioration. However, there is conflicting evidence on whether they improve patient outcomes. This may in part be related to variation in the rigour with which they are implemented and evaluated. This study aims to evaluate the implementation and effectiveness of a longitudinal patient monitoring system designed for adult patients in the unique environment of the Emergency Department (ED). Methods: A novel participatory action research (PAR) approach is taken where socio-technical systems (STS) theory and analysis informs the implementation through the improvement methodology of ‘Plan Do Study Act’ (PDSA) cycles. We hypothesise that conducting an STS analysis of the ED before beginning the PDSA cycles will provide for a much richer understanding of the current situation and possible challenges to implementing the ED-specific longitudinal patient monitoring system. This methodology will enable both a process and an outcome evaluation of implementing the ED-specific longitudinal patient monitoring system. Process evaluations can help distinguish between interventions that have inherent faults and those that are badly executed. Discussion: Over 1.2 million patients attend EDs annually in Ireland; the successful implementation of an ED-specific longitudinal patient monitoring system has the potential to affect the care of a significant number of such patients. To the best of our knowledge, this is the first study combining PAR, STS and multiple PDSA cycles to evaluate the implementation of an ED-specific longitudinal patient monitoring system and to determine (through process and outcome evaluation) whether this system can significantly improve patient outcomes by early detection and appropriate intervention for patients at risk of clinical deterioration.en
dc.description.sponsorshipHealth Research Board, the Health Service Executive and the Royal College of Physicians, Ireland (Research Collaborative in Quality and Patient Safety (RCQPS) Awards)en
dc.description.statusPeer revieweden
dc.description.versionPublished Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationWard, M., McAuliffe, E., Wakai, A., Geary, U., Browne, J., Deasy, C., Schull, M., Boland, F., McDaid, F., Coughlan, E. and O’Sullivan, R. (2017) 'Study protocol for evaluating the implementation and effectiveness of an emergency department longitudinal patient monitoring system using a mixed-methods approach', BMC Health Services Research, 17(1), pp. 67. doi:10.1186/s12913-017-2014-9en
dc.identifier.doi10.1186/s12913-017-2014-9
dc.identifier.endpage67-10en
dc.identifier.issn1472-6963
dc.identifier.journaltitleBMC Health Services Researchen
dc.identifier.startpage67-1en
dc.identifier.urihttps://hdl.handle.net/10468/3539
dc.identifier.volume17en
dc.language.isoenen
dc.publisherBioMed Centralen
dc.rights© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.en
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/en
dc.subjectLongitudinal patient monitoringen
dc.subjectEarly warning scoreen
dc.subjectEmergency departmenten
dc.subjectSocio-technical systemsen
dc.subjectParticipatory AR Process and outcome evaluationen
dc.titleStudy protocol for evaluating the implementation and effectiveness of an emergency department longitudinal patient monitoring system using a mixed-methods approachen
dc.typeArticle (peer-reviewed)en
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