Paediatric family activated rapid response interventions; qualitative systematic review

Globally it is approximated that 70 % of medical complications and deaths among hospital admissions are avoidable if signs of deterioration in clinical conditions are recognised early, escalated and followed by immediate appropriate treatments and interventions (Thomas et al., 2007). The United Kingdom (UK) Paediatric Intensive Care Audit Network 2017 report stated at least 85 % of unplanned admissions to paediatric critical care units (PCCU) are commonly associated with acute clinical deterioration (Mchale et al., 2021). The paediatric patient population especially those with complex healthcare needs, are more likely to have factors, such as a developing immune system, non-verbal communication and interaction and multiple comorbidities, which predispose them to deteriorate in health status during hospitalisation (Mchale et al., 2021). Occasionally, unanticipated influence of some of these factors on the child’s health can go unrecognised (Thomas et al., 2007, Bavare et al., 2018).

Failure to rescue is defined as staff failure to recognise early signs of deterioration, which results in patient death and has been identified as one of the largest causes of harm to patients (Burke et al., 2022, Mchale et al., 2021). Failure to rescue is described by the United Kingdom National Patient Safety Agency (NPSA) as failure to measure observations, lack of recognition of worsening vital signs; failure to clearly articulate patient assessment, delay in response to a deterioration, and failure to appreciate the severity of illness (Luettel et al., 2007).

To reduce the risk of failure to rescue, initiatives to improve safety and the quality of care for acutely ill hospitalised children has been a priority both for policy makers and clinicians. This is reflected by the implementation and integration of Rapid Response Systems (RRS), variably known as critical care outreach teams in the UK, as part of care pathways (Al-qahtani and Al-dorzi, 2010, Burke et al., 2022), an important and innovation step towards enhancing quality and safe care is the expanding of the RRS process to include patients and family activation (Institute for Family-Centred Care (USA) (2019)). Paediatric healthcare is centred upon the concept of family-centred care which promotes partnership working and considers children and their families as experts (Kuo et al., 2012). Patients and their families can often recognise changes in the child’s condition before nursing and medical staff, which is increasing the emphasis upon encouraging a system in which patients and families can escalate their concerns to increase early recognition of the deteriorating child (Strickland et al., 2019). The concept of a family-activated rapid response system is becoming widely accepted, on a National scale, as a patient safety initiative to reduce the incidence of failure to rescue (Bavare et al., 2018).

Therefore, this review was undertaken to; (i) identify current family activation rapid response interventions, and (ii) understand and analyse the use, involvement and mechanisms by which family activation works. The study aimed to identify intervention context, escalation (action) and outcomes (for example health outcomes, effectiveness of commutation) components associated with family activation. Findings from this review were used to inform further ongoing research on this subject within our organisation.

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