Article Analysis and Evaluation of Research Ethics
Article Analysis and Evaluation of Research Ethics: Find one new health care article that uses quantitative research. Do not use an article from a previous assignment, or that appears in the Topic Materials or textbook. Complete an article analysis and ethics evaluation of the research using the “Article Analysis and Evaluation of Research Ethics” template…
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Article Analysis and Evaluation of Research Ethics
Paper details
Find one new health care article that uses quantitative research. Do not use an article from a previous assignment, or that appears in the Topic Materials or textbook. Complete an article analysis and ethics evaluation of the research using the “Article Analysis and Evaluation of Research Ethics” template
Solution
Article Citation and Permalink (APA format)
Norman, S., DeCicco, F., Sampson, J., & Fraser, I. M. (2018). Emergency Room Safer Transfer of Patients (ER-STOP): a quality improvement initiative at a community-based hospital to improve the safety of emergency room patient handovers. BMJ Open, 8(12), e019553. https://doi.org/10.1136/bmjopen-2017-019553
Point and Description
Broad Topic Area/Title:
Improving the safety of emergency room patient handover. The article focuses on early identification and timely management of patient deterioration in the ER as an aspect of safe and effective healthcare provision.
Problem Statement (What is the problem research is addressing?)
Unanticipated patient deterioration within 24 hours of admission to the ER is one of the critical challenges to the critical care response team (CCRT). To address the issue, the team deploys a new framework that optimizes reporting to ensure early identification and intervention of inpatient adult ward deterioration.
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Purpose Statement (What is the purpose of the study?)
The study intended to assess if the implementation of a locally adapted checklist tool with an intentional pause and explicit management options would reduce by 50% unexpected CCRT responses to patient deterioration on general medical-surgical wards within 24 hours of admission from ED.
Research Questions (What questions does the research seek to answer?)
Will, the implementation of a locally adapted checklist tool with an intentional pause and explicit management options, would reduce unexpected CCRT responses to patient deterioration in general medical-surgical wards
Define Hypothesis (Or state the correct hypothesis based upon variables used)
The deployment of a simple three-component intervention at ED admission that enhances early identification and intervention of inpatient adult ward deterioration improves patient safety outcomes by reducing unanticipated high-risk deterioration within 24 hours of admission.
Identify Dependent and Independent Variables and Type of Data for the Variables
The independent variable was Unexpected CCRT responses, while the dependent variables were ED wait times (time from admitting order to arrival onward) and SCU admission rates.
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The population of Interest for Study
Ward medical–surgical ED admission population
Sample
1748 admissions
Sampling Method
Convenience sampling
Identify Data Collection. Identify how data were collected
EHR chart analysis, CCRT responses audit forms and ED admission documentation
Summarize Data Collection Approach
A single-center, unblinded electronic health record (EHR) chart analysis of non-elective admissions to adult medical and surgical wards from the ED were used to collect the data used in the study. The data was configured to a 1-year before-and-after period was chosen to control for seasonal variation in admission volumes. CCRT responses data were extracted from provincial critical care information system independently submitted from the investigators
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Discuss Data Analysis. Include what types of statistical tests were used for the variables.
Process and balancing measure data were tested for normality and then compared using t-tests or χ2 analysis, as appropriate, with two-tailed significance (p<0.05). Control chart analysis9 using a standardized rule-based assessment for process and quality control evaluated the before–after the change in monthly unexpected CCRT response using Microsoft Excel.
Summarize Results of Study
Following deployment of ER-STOP intervention, the risk of an unexpected CCRT response within 24 hours of admission from ED to adult medical and surgical wards was significantly decreased.
Summary of Assumptions and Limitations
- Single-site deployment limits generalizability without local adaptation
- Limited by the before-and-after, unblinded design
- However, the data collected by the study fails to factor in additional issues that influence ED wait times and SCU admission rates.
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Ethical Considerations
Evaluate the article and identify potential ethical considerations that may have occurred when sampling, collecting data, analyzing data, or publishing results. Summarize your findings below in 250-500 words. Provide rationale and support for your evaluation.
Ethical Considerations
The study received the approval of the local ethical board as it assesses the patient information. Some of the ethical considerations include informed consent, which protects the patient’s right to autonomy. Through informed consent, the study ensures that any patient participating in the study voluntarily and is treated with dignity and respect. Besides, the study also has to consider the ethical principle of beneficence, which upholds that clinical research has to be of benefit and not to harm. The fundamental principle guides the framework of implementing the intervention, especially in the ER and ICU, where the risk for harm is higher. Besides, the patient’s information had to be collected and analyzed in anonymity and confidentiality per ethical guidelines.
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Summary
The article reports on the implementation of an intervention that targets unexpected CCRT responses to patient deterioration on general medical-surgical wards within 24 hours of admission from ED. Unanticipated CCRT responses are defined as an unscheduled call to CCRT with a confirmed response documented in a team-completed audit form. The incidences occurred despite the use of validated scoring systems such as the Modified Early Warning Score (MEWS) to identify patients at risk of clinical deterioration, whose predictive value is uncertain due to methodological constraints.
Hence the CCRT team, comprising of an intensivist, an intensive care unit (ICU) nurse and a respiratory therapist, design and implement a locally validated checklist (Modified Early Warning Score+urinary catheter in situ+nurse concern) with an intentional pause and explicit management options was deployed as a modification of an existing ward transfer of accountability fax report in the emergency department (ED).
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Using data collected from EHR chart analysis, a 1-year before-and-after period, the study analyzed the performance of the intervention by measuring the unexpected adult inpatient ward deterioration occurring within 24 hours following ED admission requiring new unscheduled CCRT responses. ED wait times and SCU admission rates were also measured to determine the impact of the intervention.
The results of the article indicate that the deployment of the intervention at ED admission improved patient safety outcomes by reducing unanticipated high-risk deterioration within 24 hours of admission. Moreover, balancing and process measures reveal no increase in special unit admission rate or ED wait times with broad uptake of this simple, low-cost tool by ED staff. The study was, however, limited generalizability as it had relied on data from one site and the before-and-after, unblinded design. However, the study supports an evidence-based practice that significantly improves the quality of care provided, as well as enhancing patient safety.
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Reference
- Norman, S., DeCicco, F., Sampson, J., & Fraser, I. M. (2018). Emergency Room Safer Transfer of Patients (ER-STOP): a quality improvement initiative at a community-based hospital to improve the safety of emergency room patient handovers. BMJ Open, 8(12), e019553. https://doi.org/10.1136/bmjopen-2017-019553
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