Exploring modifications to rapid response systems in Norwegian hospital units

Area of Science:

• Healthcare interventions
• Patient safety systems
• Implementation science

Background:

• Modifications to evidence-based interventions are common, especially for complex healthcare interventions.
• Rapid Response Systems (RRSs) are vital for patient safety but lack guidance for contextual adaptations.
• The Framework for Reporting Adaptations and Modifications - Expanded (FRAME) offers a novel perspective for RRS design and implementation.

Purpose of the Study:

• To explore modifications and adaptations to RRSs in Norwegian hospitals.
• To understand how these modifications occurred and their underlying reasons using the FRAME.
• To identify factors influencing RRS intervention design and implementation.

Main Methods:

• Included nine hospital units with RRS implementation of 4-12 years.
• Collected data through focus groups and individual interviews with clinicians and leaders.
• Employed inductive content analysis followed by deductive analysis using FRAME.

Main Results:

• Identified 5 categories and 24 subcategories of RRS modifications.
• Modifications were primarily reactive, occurring in the maintenance phase, and decided at the unit level.
• Goals included improving feasibility, effectiveness, and fit, driven by resources, service structure, clinical judgment, and patient factors.

Conclusions:

• Real-life RRS modifications offer insights into intervention adaptation processes.
• Findings highlight elements modified for fit and feasibility, and those prone to fidelity inconsistency.
• Systematically anticipating modifications across all implementation stages is essential for patient safety interventions.