title: Recognising and responding to in-hospital clinical deterioration: An integrative review of interprofessional practice issues.
abstract: OBJECTIVE
  To identify, appraise and synthesise current evidence regarding organisation-wide interprofessional practice issues that facilitate or inhibit effective recognition and response to clinical deterioration, using a theoretical rapid response system model.
  
  
  BACKGROUND
  Recognition and response to clinical deterioration, in adult general medical-surgical ward patients, is embedded as routine interprofessional practice in acute healthcare organisations worldwide. The process of care escalation is complex and sometimes involves multiple health professionals from different disciplines with varying levels of expertise. While a theoretical rapid response system model offers a formalised structured approach to escalate patient care, it is unclear how the implementation of this model, or similar, influences rapid response system-wide interprofessional practices to effectively recognise and respond to clinical deterioration.
  
  
  METHODS
  An integrative review.
  
  
  METHODS
  This review was conducted using key words to systematically search four electronic bibliographic databases (PubMed, CINAHL, ProQuest Central, Cochrane Library). Twenty-nine eligible full-text papers were identified. Quality appraisal of methods was performed using recommended guidelines. Study findings were narratively coded, themed and conceptualised in the context of an organisation-wide rapid response system using an interprofessional collaborative practice framework.
  
  
  RESULTS
  Five main themes aligned with the four interprofessional collaborative practice competency domains and a learning continuum of professional development: Organisational culture, Role perceptions and professional accountability, Communication of clinical needs, Team-based practices, and Interprofessional learning opportunities in recognising and responding to clinical deterioration. Within these themes, three notable interprofessional practice issues were highlighted: professional reporting hierarchies (inhibiting), critical care outreach services (facilitating) and interprofessional relationships (facilitating).
  
  
  CONCLUSIONS
  A unique approach for exploring organisation-wide interprofessional practice issues has been presented using an interprofessional collaborative practice framework. Further interpretive organisation-wide research is necessary to develop a more in-depth and meaningful understanding of interprofessional collaborative practice issues that facilitate or inhibit effective recognition and response to clinical deterioration.
  
  
  CONCLUSIONS
  This review presents a unique system-wide approach for exploring how health professionals interprofessionally collaborate in practice to effectively recognise and respond to clinical deterioration.
authors.affiliation: School of Health Professions, Murdoch University, South Street, Murdoch, WA, Australia.|Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia.
authors.forename: Emily
authors.identifier: http://orcid.org/0000-0003-0381-5160
authors.initials: E
authors.lastname: Allen
authors.affiliation: Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia.
authors.forename: Doug
authors.identifier: http://orcid.org/0000-0002-6081-5442
authors.initials: D
authors.lastname: Elliott
authors.affiliation: Faculty of Health and Life Sciences, Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University, Oxford, UK.
authors.forename: Debra
authors.identifier: http://orcid.org/0000-0001-5252-5325
authors.initials: D
authors.lastname: Jackson
mesh_terms: D000328:Adult; D000075902:Clinical Deterioration; D003142:Communication; D003299:Cooperative Behavior; D003695:Delivery of Health Care / Q000458:organization & administration; D006282:Health Personnel / Q000523:psychology; D006801:Humans; D007400:Interprofessional Relations; D015279:Organizational Culture; D010348:Patient Care Team; D036301:Qualitative Research
keywords: clinical deterioration; communication; healthcare standards; interprofessional collaborative practice; patient safety; rapid response system