Nurses’ perspectives on delays in care escalation in an acute private hospital

Problem: Despite mandated Rapid-Response Systems (RRS), hospitals continue to see delays in escalation of care. There is a paucity of research regarding nurses’ perceptions of the reasons for care escalation delays in the private hospital setting in which there is a different model of care and hierarchy of the medical system. It is important to understand how these elements may influence the approach to escalating care. Aim: To explore nurses’ perspectives and experiences of clinical deterioration and the factors impacting on timely escalation of care in a private, non-profit hospital. Method: Twenty-three bedside and leadership nurses were purposively recruited. Qualitative descriptive methodology employed interviews and focus groups to explore knowledge of, and belief in RRS criteria and process, individual confidence, perceived barriers, and RRS education. Data were analysed thematically. Findings: Three major themes were elicited. First, hierarchy and a culture of indecisiveness. Second, gatekeeping and protocol adherence impacting on timely escalation. Third, the importance of confidence in the nurse role to escalate care. Communication barriers and inconsistent leadership were common threads across all themes. Discussion: RRS have been shown to be effective, however, if escalation criteria are implemented inconsistently, individual's prior experience can impact interdisciplinary communication, RRS processes and patient outcomes. Conclusion: The effectiveness of RRS is dependent on a supportive workplace culture, good communication, and consistent leadership. Further research is required to understand the optimal mechanisms for implementing RRS processes in private, non-profit hospitals.