Table 3

Thematic analysis of structured interview responses from the prospective data collection phase. All patients experienced a missed RRS call with an adverse clinical event

Characteristics of intervieweesFrequency of responses (n=83), n (%)
Junior ward nurse28 (33.7)
Senior ward nurse16 (19.3)
Junior doctor (intern/resident)16 (19.3)
Senior doctor (registrar/consultant)13 (15.7)
Other (eg ICU outreach nurse)18 (21.7)
Actions performed prior to activating RRS
 Awaited further review or response by medical staff43 (51.8)
 Specific treatment or investigations delaying RRS activation42 (50.6)
 Involved ICU outreach or requested ICU review28 (33.7)
 Involved senior nursing staff10 (12.0)
Explanation as to why RRS was not activated
 Felt the situation was under control in the ward setting45 (54.2)
 ICU team already involved but no ICU bed was available25 (30.1)
 Team involved were experienced in this type of patient and felt RRS activation was not required14 (16.9)
 Poor communication/prioritisation by medical team13 (15.7)
 Additional skills were not required to manage the patient8 (9.6)
 No further clinical observations had been taken6 (7.2)
 Altered thresholds for RRS activation but not documented4 (4.8)
 Thought they were too junior to activate RRS1 (1.2)
  • ICU, intensive care unit.