Table 4

Contextual influences

Contextual influencesEastwardWestward
Facilitators
  • Senior level support for improving the management of detection and response to acutely ill patients

  • Project management support for introduction and implementation of the intelligent assessment technology

  • Access to real-time electronic data on pilot wards on patients who were scoring

  • Weekly/bi-weekly feedback of electronic data trends (eg, late observations) on pilot wards enabling benchmarking

  • Development of a hospital-wide strategy for management of detection and response to acutely ill patients

  • Additional funding to facilitate start-up and implementation of the strategy

  • High-level organisational commitment to patient safety

  • Strategic aim of zero hospital cardiac arrests

  • Regular audit and feedback of data at the local level enabling benchmarking of wards

  • Multi-disciplinary team support and awareness of the strategies and tools

  • Investment in training to develop staff competencies

Barriers
  • Lack of sustained utilisation of electronic data for quality improvement purposes

  • Lack of a formalised hospital-wide strategy for management of detection and response to acutely ill patients

  • Difficulties monitoring compliance with ‘Situation-background-assessment-recommendation’ (SBAR) protocol