Key Factors and Modeling of Interprofessional Management of Clinical Deterioration in Hospital Units: A Scoping Review.

Background and purpose: Situations of clinical deterioration compromise patient safety, and their management can be a challenge for professionals. In this review, we synthesize the problematic factors for clinicians during the collective management of patient clinical deterioration in hospital units, and we provide a modeling of the action processes involved in patient safety.

Methods: Electronic databases MEDLINE, CINAHL, EMBASE, and ERIC were systematically searched, and studies were critically appraised with MMAT. Seventeen articles were identified from 1222 for full-text screening. Data were deductively coded according to the Systems Analysis of Clinical Incidents model developed by Taylor-Adams and Vincent (2004), and results were consolidated using a narrative synthesis.

Results: Faced with these uncertain and rapidly changing situations, great adaptability is essential, and the quality of social interactions is a central issue for the effectiveness of teamwork. Interprofessional management of patients in clinical deterioration is complex due to multiple factors related to patients, professionals, tasks, environment, and teamwork. Caregivers' sense of worry about the patient's evolution is a key factor in early detection and therefore in the implementation of interventions.

Implications for practice: The model of four action processes proposed (Evaluation-Solicitation-Articulation-Composition) constitutes the points of attention for patient safety. It aims to guide the activities of the interprofessional collective involved.