Validation of a modified early warning score-linked Situation-Background-Assessment-Recommendation communication...

Area of Science:

• Healthcare communication strategies
• Clinical deterioration monitoring
• Patient safety protocols

Background:

• Early detection of patient deterioration is crucial to prevent adverse events like cardiac arrest or death.
• Structured communication tools enhance the reporting of patient status by nurses.
• Existing tools may require adaptation to local healthcare contexts.

Purpose of the Study:

• To develop and validate a modified Situation-Background-Assessment-Recommendation (SBARR) communication tool.
• To integrate components of the Cape Town modified early warning score (Mews) vital signs chart.
• To improve the reporting of early signs of clinical deterioration.

Main Methods:

• A mixed-methods approach was employed for instrument development and validation.
• The study utilized a sequential three-phase process: cognitive interviews, content validation, and inter-rater reliability testing.
• Expert nurses and doctors in Cape Town government hospitals participated in the validation phases.

Main Results:

• Cognitive interviews led to modifications in 35.71% of the initial communication tool items.
• Content validation by 18 experts showed high agreement, with only 8.2% of items requiring revision.
• Inter-rater reliability testing demonstrated substantial to full agreement (Cohen's kappa .61-1) on 82% of the 45 items in the final tool.

Conclusions:

• The modified SBARR communication tool, linked to the early warning score, is the first of its kind developed and validated in South Africa.
• The tool is valid and reliable for use in the local South African context.
• This validated tool can assist South African nurses in communicating critical patient information to doctors, thereby preventing serious adverse events and serving as a model for other African nations.