UCSF

Identification of patients at risk for deterioration initially started with studies that focused predictors of cardiopulmonary and neurovascular demise. This spawned research to evaluate the utility of predictor models followed by the performance studies of early warning track and trigger systems in adults. Mandates to provide emergency services early in the course of instability in the 1990s fueled research to analyze the outcomes of rapid response systems and early warning systems in both adults and pediatrics. Recently studies have looked at system and human factors that impact failure to rescue. Given the dearth of systems research in early prevention of deterioration in pediatrics this study was designed to explore what nurses do during deterioration and the factors that impact their actions.

Interview and observations of 13 pediatric nurses and 16 parents of pediatric patients admitted to a non ICU environment were conducted at one academic children’s hospital in the Northwest USA. Grounded theory methods were used to guide data collection and analysis. Findings describe nursing actions associated with nursing surveillance of instability as well as factors that facilitate or impede surveillance efficacy. We present a theoretical model for how nurses and parents integrate their roles in surveillance of pediatric patients. We also further developed a sociotechnical model of nursing surveillance.