title: Factors influencing escalation of care by junior medical officers.
abstract: Patients can acutely deteriorate unexpectedly. Junior medical officers (JMOs) are often first to review patients who become unwell. Opportunities to escalate care to a senior colleague may exist prior to the need for a rapid response team review. Little is known about the factors that influence JMO decisions to escalate care. In this study, our objective was to investigate the self-reported factors that influence escalation of care by JMOs in a university-affiliated, tertiary level hospital. We designed a face-to-face questionnaire of JMOs using standardised introduction to minimise interviewer bias. Fifty JMOs participated in the study (a 100% response rate). Most (63.3%) felt that they would be able to identify a clinically deteriorating patient. They would be more likely to escalate care if they were not familiar with the patient's clinical problem. If handover plans were seen to be adequate, JMOs felt it was less necessary to escalate care. Few JMOs (12%) agreed that they limited escalation due to fear of criticism or fear of conflict with senior medical staff. Although 36% agreed that they were concerned about waking seniors overnight, only 6% feared that escalating care overnight would affect their future career prospects. Escalation of care appears to be mostly influenced by the confidence and familiarity of the JMO with the cause of deterioration. JMOs identified clear handover with documented goals of treatment and suggested actions in event of clinical deterioration as the best means by which to improve the process of escalation of care for clinically deteriorating patients.
authors.affiliation: Emergency Medicine, Austin Health, Heidelberg, Victoria.
authors.forename: J A
authors.initials: JA
authors.lastname: Rotella
authors.affiliation: Intensive Care, Austin Health, Heidelberg, Victoria.
authors.forename: W
authors.initials: W
authors.lastname: Yu
authors.affiliation: Austin Health, Heidelberg, Victoria.
authors.forename: J
authors.initials: J
authors.lastname: Ferguson
authors.affiliation: Intensive Care, Austin Health, Heidelberg, Victoria.
authors.forename: D
authors.initials: D
authors.lastname: Jones
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003422:Critical Care / Q000379:methods* / Q000706:statistics & numerical data; D016638:Critical Illness; D018450:Disease Progression; D005260:Female; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data*; D008297:Male; D008505:Medical Staff, Hospital / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D014739:Victoria
keywords: clinical deterioration; escalation of care; intern; junior medical officer; resident