EXPLORING THE EXPERIENCES OF JUNIOR DOCTORS IN THEIR RECOGNITION AND RESPONSE TO CLINICALLY DETERIORATING PATIENT IN THE GENERAL WARD

Abstract

Background: There is growing evidence of adverse events such as failure-to-rescue events and unplanned admissions to Intensive Care Unit(ICU). Junior doctors are often the first medical personnel to perform a medical review thereafter, provide appropriate, timely treatment for the patient. Their lack of prompt recognition and response to deteriorating patient would lead to adverse outcomes. Aims: this study aimed to explore the factors that infleunce junior doctors in their recognition and response to clinical deteriorating patients in the general ward setting. Method: A descriptive, exploratory qualitative study using the critical incident technique was conducted. Twelve junior doctors with one month to 4 years of experience working with clinical deterioration in the general ward, were recruited using purposive sampling. Individual face-to-face interviews were conducted using semi-structure interview questions. Data analysis was using thematic analysis. Findings: Four themes that infleunce junior doctor’ experiences with clinical deterioration emerged: ‘Trigger’ by nurses, Communication, Clinical judgment and Hierarchy division. Triggering’ based on an isolated vital sign is not comprehensive enough for identifying deterioration. Handovers and nurses’ communication in a salient and sufficient manner, using appropriate mode aid junior doctors to identify early cues of deterioration. Clinical judgement of junior doctors developed through clinical experience and fears that result from Hierarchy division influences junior doctors’ response to patient deterioration. Conclusion: The findings identified the pivotal role that junior doctors play in recognizing, responding and manging deterioration. It highlights the need for education development and system modifications to maximize the role of junior doctors with regards to deterioration. Education could be driven towards the introduction of interprofessional education and simulation sessions to increase communication skills and experiential learning experiences with patient deterioration, respectively. Strategies to modify the system include implementing a standardize handover process and Rapid Response Team(RRT) to aid junior doctors in their role.