Detection and management of clinical deterioration in a virtual hospital: A work system analysis

Timely detection and management of patient deterioration is critical to minimise adverse events and death. The study aimed to understand the processes of detecting and managing deterioration in a virtual care environment, assess work system barriers and facilitators, and identify changes needed to the technology. Data were collected using interviews and document reviews and presented as process map and a work system analysis. We found that nurses and patients were key stakeholders in detecting deterioration, while management of deterioration was primarily performed by doctors and patients. We uncovered more barriers in the detection process than the management process, with the majority of barriers relating to technologies. Most facilitators related to people and included clinician expertise and carer support. Duplication of work and difficulty assessing some signs virtually were also revealed as barriers to the deterioration detection process. This study led to work system changes to mitigate some of these barriers.