A research article detailing findings from the Institute for Health Transformation’s PRONTO (Prioritising Responses Of Nurses To deteriorating patient Observations) study has been named the Top Research Article of 2022 by the BMJ Quality and Safety. The study measured the effectiveness of an intervention to improve nurses’ recognition and response to abnormal vital signs.

Vital signs are the most common assessment technique employed in health care. Early detection of physiological signs of deterioration requires frequent and accurate measurement of vital signs by nurses, intervention and escalation to appropriate clinicians. Failure to do so may result in serious patient complications and have significant cost implications for health services, says PRONTO study lead Alfred Deakin Professor Tracey Bucknall.

Professor Bucknall is a pioneering decision scientist focused on improving clinical decision-making to enhance patient outcomes.

Tracey is a co-director of IHT’s Centre for Quality and Patient Safety Research (QPS) and Chair in Nursing (Alfred Health) at Deakin University’s School of Nursing and Midwifery.

‘Despite a growing body of evidence that shows the benefit of early recognition and management of patients, there is a gap between what the research is telling us that we need to do and what happens in the clinical setting. With the PRONTO study, we sought to look at ways to close this gap,’ Tracey said.

‘The study was a randomised control trial across 36 inpatient wards at 4 metropolitan hospitals in Victoria,’ she said.

‘Ward staff at all 36 wards received access to clinical practice guidelines. Nurses in 18 of those wards received additional facilitated training to promote understanding and adherence to the recommendations in the clinical practice guidelines.’

‘This training included nurse facilitators conducting presentations to ward staff, having individual discussions with staff, placing reminder posters around the wards, conducting clinical audits and feeding back the results to staff to identify areas for improvement.’

A first of its kind, PRONTO found evidence of sustained early recognition within the wards that received the facilitation 6 months after receiving the additional support, Tracey said.

‘Importantly, the wards that received the facilitated training saw a reduction in patients’ length of stay in hospital,’ she said.

‘Following PRONTO, my team is interested in using artificial intelligence to predict patients at risk of clinical deterioration and to further support collaboration amongst clinical teams in dealing with these very sick patients.’

The PRONTO study received funding from the National Health and Medical Research Council and partner organisations: Alfred Health, Eastern Health, Monash Health, Australian Commission on Safety and Quality in Health Care and SA Health.