title: The effectiveness of education in the recognition and management of deteriorating patients: A systematic review.
abstract: BACKGROUND
  Survival from in-hospital cardiac arrest is poor. Clinical features, including abnormal vital signs, often indicate patient deterioration prior to severe adverse events. Early warning systems and rapid response teams are commonly used to assist the health profession in the identification and management of the deteriorating patient. Education programs are widely used in the implementation of these systems. The effectiveness of the education is unknown.
  
  
  OBJECTIVE
  The aims of this study were to identify: (i) the evidence supporting educational effectiveness in the recognition and management of the deteriorating patient and (ii) outcome measures used to evaluate educational effectiveness.
  
  
  METHODS
  A mixed methods systematic review of the literature was conducted using studies published between 2002 and 2014. Included studies were assessed for quality and data were synthesized thematically, while original data are presented in tabular form.
  
  
  RESULTS
  Twenty-three studies were included in the review. Most educational programs were found to be effective reporting significant positive impacts upon learners, patient outcomes and organisational systems. Outcome measures related to: i learners, for example knowledge and performance, ii systems, including activation and responses of rapid response teams, and iii patients, including patient length of stay and adverse events. All but one of the programs used blended teaching with >87% including medium to high fidelity simulation. In situ simulation was employed in two of the interventions. The median program time was eight hours. The longest program lasted 44h however one of the most educationally effective programs was based upon a 40min simulation program.
  
  
  CONCLUSIONS
  Educational interventions designed to improve the recognition and management of patient deterioration can improve learner outcomes when they incorporate medium to high-fidelity simulation. High-fidelity simulation has demonstrated effectiveness when delivered in brief sessions lasting only forty minutes. In situ simulation has demonstrated sustained positive impact upon the real world implementation of rapid response systems. Outcome measures should include knowledge and skill developments but there are important benefits in understanding patient outcomes.
authors.affiliation: School of Nursing and Midwifery, Monash University, PO Box 527, Frankston, VIC 3199, Australia. Electronic address: clifford.connell@monash.edu.
authors.forename: Clifford J
authors.initials: CJ
authors.lastname: Connell
authors.affiliation: School of Nursing and Midwifery, Monash University, PO Box 527, Frankston, VIC 3199, Australia; School of Nursing and Midwifery, Plymouth University, UK. Electronic address: ruth.endacott@monash.edu.
authors.forename: Ruth
authors.initials: R
authors.lastname: Endacott
authors.affiliation: Monash Health, Dandenong Hospital Emergency Department, 135 David Street, Dandenong, VIC 3175, Australia. Electronic address: Jennifer.Jackman@monashhealth.org.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Jackman
authors.affiliation: School of Nursing and Midwifery, Monash University, 100 Clyde Road, Berwick 3806, Australia. Electronic address: noelleen.kiprillis@monash.edu.
authors.forename: Noelleen R
authors.initials: NR
authors.lastname: Kiprillis
authors.affiliation: Bass Coast Health, PO Box 120, Wonthaggi, VIC 3995, Australia. Electronic address: louise.sparkes@basscoasthealth.org.au.
authors.forename: Louise M
authors.initials: LM
authors.lastname: Sparkes
authors.affiliation: School of Nursing, Midwifery and Healthcare, Federation University, Gippsland Campus, Northways Road, Churchill, VIC 3842, Australia. Electronic address: s.cooper@federation.edu.au.
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Cooper
mesh_terms: D064648:Critical Care Nursing / Q000193:education*; D019468:Disease Management; D018450:Disease Progression; D004506:Education, Nursing / Q000379:methods*; D004521:Educational Measurement; D019983:Guideline Adherence; D006801:Humans; D009730:Nursing Assessment; D000066908:Simulation Training; D055986:Vital Signs
keywords: Early warning scores; Education; Medical emergency team; Patient deterioration; Rapid response systems; Simulation; Track and trigger; Training