Katie Dainty

Years since first academic appointment: Less than 5 years

Title: Improving the Care of Admitted Patients Who Deteriorate while Still in the Emergency Department: A Qualitative Study of Multi-disciplinary Staff Perspectives

Full author list: Dainty KN, Seaton MB, McGowan M, Toma A

Background: The early recognition, timely response and optimal management of patients with acute illness are paramount in determining their clinical outcomes. In the emergency department (ED), competing demands on health care workers creates error-producing conditions that pose a serious risk to patient safety (1).  One of these conditions is the challenge of identifying deteriorating patients.  Without the means to identify and intervene early in these situations, further deterioration to cardiac arrest and death may occur.  In order to improve the care and outcomes of deteriorating patients in the ED, we sought to understand how health care providers currently identify, respond to, and care for these patients, as well as discern staff perspectives about barriers and facilitators to their care.

Methods: This project will employ qualitative methodology.  Qualitative research emphasizes understanding the different meanings, perceptions, and experiences that people have of social phenomena and processes, and is particularly useful in unpacking some of the complex issues inherent to health care delivery and quality improvement, such as the ways in which interpersonal and workplace relations may be impacted.

The primary method for collecting data will be in-depth, semi-structured interviews with various health care team members at St. Michael’s Hospital.  Participants will be approached from multiple stakeholder groups in order to ensure there is representation from different components of the front-line experience of providing care for deteriorating ED patients: ED registered nurses, emergency physicians and residents, internal medicine physicians and residents, neurosurgery physicians and residents, as well as physicians and residents from other select services, such as cardiovascular and trauma.  Senior administrative leadership from the units involved in care for these patients (Chiefs of the ED, internal medicine, and neurosurgery) will also be approached for participation in order to provide background information and context to the perspectives and experiences shared by the front-line staff. All interviews will be conducted in person, audio-taped, and transcribed verbatim. Data management will be facilitated using NVivo software (version 11).

In keeping with the iterative process of qualitative methodology, data analysis will occur in conjunction with data collection.  The interview transcripts will be reviewed and coded by research staff with qualitative methodological expertise.  Comparisons within and across interviews will be conducted (the constant comparison technique) in order to continuously monitor emerging themes and general areas for further exploration.  All analysis will be conducted independently by two of the team members and discussed with research colleagues on an ongoing basis.

Potential Impact on EM: Insights from this study provide contextual knowledge of crucial importance to the development of an intervention that will be appropriate, effective in improving the care and outcomes of deteriorating patients, and very relevant to ED teams across the country.  This knowledge may also facilitate the optimization of care for these patients on other units beyond the ED.


  • Are there participant groups that we haven’t thought of?
  • Scalability – is this an issue in other EDs?  Should we make this a multi-centre project?  If yes, is anyone interested in hosting at their site?
  • What will be the best method of dissemination of our findings?