title: The factors that influence junior doctors' capacity to recognise, respond and manage patient deterioration in an acute ward setting: An integrative review.
abstract: OBJECTIVE
  Junior doctors are frequently the first doctor to be called by a nurse to review patients whose clinical status has declined in hospital wards, yet little is known about how well prepared they are to deal with this situation. This paper aims to identify the factors that influence junior doctors' early recognition and management of patient deterioration in an acute ward settings.
  
  
  METHODS
  Integrative review methodology was used to allow for the inclusion of broad research designs, summarising current knowledge from existing research and identify gaps in the literature. Quantitative, qualitative and mixed method studies were included. An electronic database search including PubMed, Medline and Scopus was performed. Research articles, exploring junior doctors' skills specific to critically ill, or deteriorating patients, technical and non-technical skills and failure to rescue were included.
  
  
  RESULTS
  Thirty-three articles were included, of which eighteen were quantitative, six qualitative and nine mixed methods The majority of the studies, eighteen out of thirty-three, were from the United Kingdom. The evidence showed that the capacity for junior doctors to effectively deal with patient deterioration was influenced by: educational models that incorporated non-technical skills; the integration of high quality clinical simulation into education; and the level and type of supervision in the clinical environment.
  
  
  CONCLUSIONS
  The factors that influence junior doctors' capacity to recognise, respond and manage patient deterioration in an acute ward settings are complex. This review indicates that there is substantial room for improvement in junior doctors' capacity to deal with patient deterioration. Evidence suggests preparation of junior doctors in the recognition and management of the deteriorating patient is influenced by effective simulation education and clinical experiential exposure over time. More accessible supervision for junior doctors in acute wards is recommended to avert error and delays in the appropriate escalation of care in the deteriorating patient.
authors.affiliation: Monash Rural Health - Bendigo, Office of Research, P.O. Box 666, Bendigo, Victoria 3550, Australia. Electronic address: alcal6@student.monash.edu.
authors.forename: Adele
authors.initials: A
authors.lastname: Callaghan
authors.affiliation: University of Tasmania and Tasmanian Health Organisation (North), Australia. Electronic address: leigh.kinsman@utas.edu.au.
authors.forename: Leigh
authors.initials: L
authors.lastname: Kinsman
authors.affiliation: Acute Care and Research Development, School of Nursing, Midwifery and Healthcare, Federation University Australia, Gippsland Campus, Churchill, Victoria, Australia. Electronic address: s.cooper@federation.edu.au.
authors.forename: Simon
authors.initials: S
authors.lastname: Cooper
authors.affiliation: Monash University, School of Rural Health and HealthPEER, Australia. Electronic address: natalie.radomski@monash.edu.
authors.forename: Natalie
authors.initials: N
authors.lastname: Radomski
mesh_terms: D002983:Clinical Competence; D000075902:Clinical Deterioration; D006801:Humans; D007396:Internship and Residency; D008505:Medical Staff, Hospital
keywords: Clinical deterioration; Escalation of care; Failure to rescue; Integrative review; Junior doctor; Patient deterioration; Technical and non-technical skills