A realistic evaluation of early warning systems and acute care training for early recognition and management of deteriorating ward-based patients

It followed the principles of Realist Evaluation research which allowed empirical data to be gathered to test and refine Rapid Response System programme theory. This approach used a variety of mixed methods to test the programme theories including individual and focus group interviews, observation and documentary analysis of EWS compliance data and ALERT training records. <br><br>Data synthesis found similar regularities or factors enabling or constraining successful implementation across the case study sites.

Findings showed that personal (confidence; clinical judgement; professional accountability; personality), social (ward leadership; communication), organisational (workload; time pressures; staffing levels and skill-mix), educational (constraints on training and experiential learning) and cultural (delegation of observations, referral hierarchy; rigid recording practices) factors influenced the impact of EWS and acute care training outcomes.

There were also differences noted between medical and surgical wards across both case sites. <br><br>RRS theory refinement using realist evaluation explained what works, for whom in what circumstances. Future service provision needs to consider improved staffing levels and skill mix of qualified nurses on medical wards; flexible implementation of protocols underpinned by empowerment and clinical judgement; on-going experiential ward-based learning and interprofessional educational opportunities during acute care training to enable the success and sustainability of Rapid Response Systems.