Elsevier

Resuscitation

Volume 65, Issue 3, June 2005, Pages 329-336
Resuscitation

Impact of a one-day inter-professional course (ALERT™) on attitudes and confidence in managing critically ill adult patients

https://doi.org/10.1016/j.resuscitation.2004.12.011Get rights and content

Abstract

Anecdotal evidence suggests that anxiety and lack of confidence in managing acutely ill patients adversely affects performance. We evaluated the impact of attending an ALERT™ course on the confidence levels and attitudes of healthcare staff in relation to the recognition and management of acutely ill patients. A questionnaire, which examined knowledge, experience, confidence and teamwork, was distributed to participants prior to commencing an ALERT™ course. One hundred and thirty-one respondents agreed to participate in a follow-up questionnaire 6 weeks after completing the course. Respondents reported significantly more knowledge (pre 5.47 ± 1.69, post 7.37 ± 1.22; p < 0.01) in recognising a critically ill patient after attending an ALERT™ course. Mean scores for respondents’ confidence in their ability to recognise a critically ill patient (pre 6.04; post 7.71; t = 11.74; p < 0.01), keep such a patient alive (pre 5.70; post 7.30; t = 10.01; p < 0.01) and remember all the life-saving measures (pre 5.60; post 7.32; t = 11.71; p < 0.01) were increased. Fewer respondents were very worried about being responsible for a critically ill patient (pre 13; post 2; χ2 = 8.55; p < 0.003). There was a significant increase in the number of respondents indicating that they would use a system of assessment for acute illness (pre 23; post 37; χ2 = 4.25; p = 0.035). More staff said that they would approach a registrar or a consultant for help (χ2 = 3.29, n = 131, p < 0.05; χ2 = 7.51, n = 131, p < 0.01). There was a significant improvement in attendees’ confidence in working in an interdisciplinary team when caring for critically ill patients (pre 40.66; post 42.91; t = 2.32; p = 0.05). We conclude that attending an ALERT™ course has beneficial effects on the confidence levels and attitudes of healthcare staff in relation to the recognition and management of acutely ill patients.

Introduction

Recent evidence suggests that some hospital patients receive sub-optimal ward care, resulting in potentially avoidable cardiac arrests, deaths and intensive care admissions [1], [2], [3], [4], [5]. Ward medical and nursing staff often miss signs of clinical deterioration and treatment is frequently delayed or inappropriate [1], [2], [3], [4], [5]. Poor management of the simple aspects of acute care, for example the management of the patient's airway, breathing and circulation, oxygen therapy, fluid balance and monitoring are often implicated. Failures of organisation, a lack of knowledge [6], failure to appreciate the clinical urgency of a situation, a lack of supervision, failure to seek advice and poor communication may also play a role. Similar concerns about acute care were reflected in the recommendations of the UK Department of Health document “Comprehensive Critical Care” published in 2000 [7].

Anecdotal evidence and data from an unpublished local survey in Portsmouth also suggest that anxiety and lack of confidence in managing acutely ill patients adversely affects performance. In 1999, in response to local concerns, we designed a one-day inter-professional course in care of the acutely ill adult patient—Acute Life-threatening Events, Recognition and Treatment (ALERT™) [8]—which is now taught in more than 150 centres in the UK.

The educational objectives underpinning the design of the ALERT™ course include an improved knowledge of critical illness, better and earlier recognition and management of acutely ill patients, using a systematic plan of assessment, enhanced inter-professional working patterns and communication, including asking for senior help, and increased confidence when facing clinical emergencies. As part of ongoing evaluation of the course, we wished to determine if and, if so, how ALERT™ had made an impact on staff attitudes to managing acutely ill patients.

Section snippets

Methods

A questionnaire (see Appendix A), based upon a series of piloted designs by the authors, was distributed to all participants prior to their commencing one of 23 ALERT™ courses held in the UK between August 2002 and January 2003. Data were collected on profession, age and sex of course participants.

Results

Of the 329 practitioners attending 23 different ALERT™ courses, 315 individuals handed in completed initial questionnaires, which were then passed on to the researchers. This sample consisted of 67 males and 244 females (four did not specify). Six weeks later, a total of 131 (41.6% of initial group) returned the second questionnaire (23 males, 107 females and 1 unknown). The professions of the respondents to both questionnaires are listed in Table 1. There was no significant difference in the

Discussion

The data show that attendance at an ALERT™ course significantly influenced the attitudes of healthcare professionals faced with managing acutely ill patients. In particular, participants had greater confidence in their ability to recognise when patients were critically ill, keep them alive and remember life saving procedures. They stated that they were also more likely to use a systematic approach to their assessment. After the course, participants felt that they had more knowledge and appeared

Conclusions

Attendance at an ALERT™ course appears to have a significant effect on the attitudes of healthcare professionals who may be faced with managing acutely ill patients. The course appears to improved attendees’ confidence in their ability to recognise critical illness, keep patients alive and remember essential, but simple, life saving procedures. Course attendance also appears to improve attendees’ confidence in working as part of an interdisciplinary team and approaching senior members of staff

Conflict of interest statement

Peter Featherstone, Gary Smith and Vicky Osgood are members of the ALERT™ course development group.

Acknowledgements

The authors wish to acknowledge the assistance of Ms Amy Drahota at Portsmouth University, Mandy Smale and Jackie McBride at Portsmouth Hospitals NHS Trust, and the staff and course attendees at the 23 participating centres.

References (25)

  • H. Cooligan

    Research methods and statistics in psychology

    (1999)
  • Foster K, Jackson B, Thomas M, et al. (1995). General Household Survey 1993. Office of Population Censuses and Surveys,...
  • Cited by (55)

    • The impact of a multimodal education strategy (the DeTER program) on nurses’ recognition and response to deteriorating patients

      2018, Nurse Education in Practice
      Citation Excerpt :

      All eight studies reviewed discussed use of similar frameworks (track and trigger charts), technical and/or nontechnical tools to educate nurses and interprofessional teams. Three of the eight studies used before and after (pre-test, post-test) designs (Featherstone et al., 2005; Gordon and Buckley, 2009; Harvey et al., 2014). One employed a comparative study with non-randomised control group (Mitchell et al., 2010).

    • The factors that influence junior doctors’ capacity to recognise, respond and manage patient deterioration in an acute ward setting: An integrative review

      2017, Australian Critical Care
      Citation Excerpt :

      However, value was also dependent upon clinical practice opportunities during the shadowing period. In contrast, an evaluation of an Acute Life-threatening Events, Recognition and Treatment (ALERT) course from a larger cross-site cohort study reported significant improvements in participant knowledge, confidence and interdisciplinary teamwork when caring for deteriorating patients.40 Lack of confidence or competence in procedural skills was the most common theme.36,47,49,51,54,58–63,66,67

    View all citing articles on Scopus

    A Spanish and Portuguese translated version of the Abstract and Keywords of this article appears at 10.1016/j.resuscitation.2004.12.011.

    View full text