Realistic Evaluation of Early Warning Systems and the Acute Life-threatening Events--Recognition and Treatment training course for early recognition and management of deteriorating ward-based patients: research protocol.

Aim: This paper is a description of a study protocol designed to evaluate the factors that enable or constrain the delivery and sustainability of Early Warning Systems and the Acute Life-threatening Events--Recognition and Treatment training course in practice.

Background: Rapid response system initiatives have been introduced to try to improve early detection and treatment of patients who deteriorate on general hospital wards. However, recent systematic reviews of the effectiveness of these initiatives show no effect on patient outcomes. Systematic reviews and professional consensus recommend that future research should focus on a broader range of process and outcome measures which consider the social, behavioural and organizational factors that had an impact on the delivery of these initiatives.

Design: The design is a multiple case study on four wards in two hospitals in Northern Ireland that have implemented Early Warning Systems and Acute Life-threatening Events--Recognition and Treatment training. Data will be collected from key stakeholders using individual and focus group interviews, non-participant observation, Acute Life-threatening Events--Recognition and Treatment training records and audit of patients' observation charts and medical notes. Realistic Evaluation of the data will enable the development and refinement of theories to explain which mechanisms work in a particular context to achieve desired outcomes.

Discussion: This study will produce important information that will contribute to knowledge of the organizational processes that have an impact on the delivery of initiatives to identify, respond and manage acutely ill patients in hospital.