Patients', Relatives' and Healthcare Professionals' Experiences and Perceptions of Raising Concerns About Acute Deterioration: A Qualitative Case Study

AIM: To explore adult patients', relatives', and healthcare professionals' experiences of acute deterioration and perceptions of patient/family involvement in raising concerns. DESIGN: A collective case study underpinned by implementation science. METHODS: Individual and focus group semi-structured interviews were conducted with patients, relatives and healthcare professionals who had experience of deterioration across two urban hospitals. The interview schedule was informed by the Theoretical Domains Framework of behaviour change and a concurrent review of patient notes was undertaken to contextualise the deterioration experience. Data was analysed using thematic analysis. FINDINGS: Between March and October 2019, 12 patients, 11 relatives, and 32 healthcare professionals were interviewed. Findings revealed that patients and relatives can detect deterioration, and they highlighted challenges and benefits in their involvement in raising concerns. Perspectives from all stakeholders highlighted an urgent need to provide better support and mechanisms for patients and relatives in escalating deterioration. These include the need to co-design innovative interventions that focus on informing patients/relatives of the main signs of deterioration, key steps to take when calling for help, and their role in the process. CONCLUSION: Understanding the perceived challenges and benefits of patient and family-initiated care escalation provides a strong theoretical and practical foundation for designing and implementing an effective intervention. IMPACT: The findings highlight key processes and intervention components essential for developing a patient and family-initiated escalation of care intervention. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: This insight will support the co-design and implementation planning of an intervention aimed at preventing or reducing deterioration by empowering patients and their families to escalate concerns. REPORTING METHOD: The COREQ checklist was used as a guide for reporting the study. PATIENT OR PUBLIC CONTRIBUTION: Patients, relatives and healthcare professionals were involved in the co-design of the study.