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Consensus on patient cases for hospitalised children with a high paediatric track and trigger tool score that raises
Claus Sixtus Jensen1,2, Hanne Vebert Olesen3, Hans Kirkegaard2
1Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus N, Denmark claus.sixtus@skejby.rm.dk.
Insights
Healthcare professionals can downgrade high Paediatric track and trigger tool (PTTT) scores when clinical judgment differs from automated alerts. This study sought consensus on when to override PTTT scores based on experience, finding agreement in six patient cases.
Area of Science:
- Pediatric critical care
- Clinical informatics
- Healthcare quality improvement
Background:
- Paediatric track and trigger tools (PTTTs) aid in detecting critical illness in hospitalized children.
- Nurses sometimes deviate from PTTT protocols when automated scores conflict with clinical judgment.
- This study addresses the discrepancy between PTTT scores and clinical expertise.
Purpose of the Study:
- To reach a consensus on whether healthcare professionals can downgrade high PTTT scores that seem unreasonable based on clinical experience.
- To explore scenarios where clinical expertise might override automated PTTT alerts.
Main Methods:
- A two-round modified Delphi technique was employed.
- 221 participants completed round 1, and 101 completed round 2.
- Consensus was determined using a 9-point Likert scale, IQR, and median calculations for 14 patient cases.
Main Results:
- Consensus was reached on 6 out of 14 patient cases where high PTTT scores did not align with healthcare professionals' concerns.
- Round 1 achieved consensus on 2 cases, and Round 2 added consensus on 1 more case.
- The research group included 3 additional cases based on predefined criteria.
Conclusions:
- A consensus was achieved on six patient cases supporting the downgrading of high PTTT scores when clinical judgment suggests otherwise.
- This highlights the importance of integrating clinical expertise with automated monitoring tools.
- Findings suggest a need for flexible PTTT protocols that accommodate professional experience.
Background:
Paediatric track and trigger tools (PTTTs) based on vital parameters have been implemented in hospitals worldwide to help healthcare professionals identify signs of critical illness and incipient deterioration in hospitalised children. It has been documented that nurses do not use PTTT as intended, but deviate from PTTT protocols because, in some situations, PTTT observations make little sense to them. The present study aimed to reach consensus on whether automatically generated PTTT scores that are higher than deemed reasonable by healthcare professionals according to their professional experience and clinical expertise may be downgraded.
Methods:
A two-round modified Delphi technique was used to explore consensus on 14 patient cases for hospitalised children with a high PTTT score that did not raise concerns by systematically collating questionnaire responses. Participants rated their level of agreement on a 9-point Likert scale. IQR and median were calculated for each case.
Findings:
A total of 221 participants completed round 1 and 101 participants completed round 2. Across the two rounds, majority of the participants were from paediatric departments, nurses and women. In round 1, consensus on inclusion was reached on 2 of the 14 cases. In round 2, consensus was reached on one additional patient case. Three of the 11 non-consensus cases remaining after rounds 1 and 2 were included by the research group based on predefined criteria.
Conclusion:
In conclusion, a consensus opinion was achieved on six patient cases where the child had a high PTTT score but where the healthcare professionals were not as concerned as indicated by the PTTT score.
