The RESPOND Programme
Problem and Approach
“If you have been working in an environment for some time, you can argue it is easy to assume certain procedures are of common knowledge. However, with the high turn-over of staff, use of bank/agency resources, and high workload, this user-friendly summary of “what can I do” is key to supporting the juniors. Although we do have our policies and procedures, working in an unfamiliar environment, or unfamiliar situations could cause confusion and oversight." Misha Denise Virtudazo, CCOT Lead; MET Lead Nurse; Divisional Non-Medical Research Lead (WMX), in reference to the SEPs
“RESPOND trial ignites team dynamics, engagement and awareness fostering interprofessional relationships and communication improving response and outcomes in surgical patients that deteriorate during their care. It has been enlightening to focus on human factors as a necessary skill to improve clinical care.” Ms Brooke Puttergill Endocrine and General Emergency Surgeon, RESPOND Trial Pilot Stoke Mandeville Hospital
Systems issues inhibit the ability for doctors and nurses to quickly escalate and coordinate effective responses to patient deterioration after emergency surgery.
In Emergency General Surgery (EGS), which deals mainly with patients with severe abdominal pain, the death rate after exploratory abdominal surgery to find out what’s wrong (called laparotomy) is five times higher than for similar routine surgery. Death rates after routine major surgery are lower in bigger hospitals than in smaller ones. We know this is not because larger units have less complications after surgery, but because they respond to them more effectively. An effective response needs both early detection of problems and an efficient rescue system. Monitoring patients’ blood pressure, temperature, heart and breathing rates more reliably has not reduced death rates consistently, suggesting that it is more important to improve rescue systems. Research on why rescue systems sometimes don't work has highlighted communication and co-operation problems, and difficulties in getting specialist help quickly. Involving patients and families in the response may improve this process.
We have developed a four-strand intervention to address the systems issues that contribute to Failure to Rescue rates:
A larger version of the Key Driver Diagram above is available to download.
The four strands include:
- The Surgical Escalation Procedure (SEP) which outlines options for HCAs, nurses and junior doctors at each stage in the deterioration to optimise their decision making. For more information, please see the “For RESPOND Nurses” and “For RESPOND Doctors” tabs.
- Patient’s Urgent Help Line which provides patients with a phone number to call if they are in need of care for urgent care to prevent deterioration. For more information, please see the “For RESPOND Nurses” tab.
- RICHER Communication Tool, which stands for “Rapid Introduction, Criticality, History, and Expect Response” and is intended to help FY1s quickly and effectively coordinate care with service departments upon patient deterioration. For more information, please see the “For RESPOND Doctors” tab.
- Team Strengthening, which provides tangible support to improve multidisciplinary team work to facilitate effective responses to patient deterioration. For more information, please see the “For RESPOND Leaders”, “For RESPOND Nurses”, and “For RESPOND Doctors” tabs.