Co-design of a patient and family-initiated escalation of care intervention to detect and refer patient deterioration: Research protocol.

Aim: To co-design a patient and family-initiated intervention to improve the detection and escalation of patient deterioration on acute adult hospital wards in Northern Ireland and the Republic of Ireland.

Design: The design is a collective case study approach in an acute hospital in Northern Ireland and the Republic of Ireland using an adapted co-design approach and Medical Research Council framework guidelines.

Methods: Data will be collected from key stakeholders (patients, relatives, and healthcare professionals) using individual and focus group interviews and a review of patients' records. This will inform the development of a co-designed intervention and implementation strategy. The developed prototype will be further refined and optimized following a feedback session with stakeholders from each hospital site. This study was funded in February 2018 and Research Ethics Committee approval was granted in March 2019.

Discussion: This study will contribute to the growing knowledge base in relation to the interventions that improve the escalation of patient deterioration. It will also contribute to the intelligence, evidence and understanding of the role of patient and family participation in the detection and referral of clinical deterioration in acute adult hospital settings.

Impact: There is an ongoing need to introduce systems or mechanisms in acute care hospital settings which allow patient or family members to have a greater role in escalating care when they are concerned about patient deterioration. To date there is limited evidence of rigorous studies examining this area and this study will use stakeholder engagement and involvement to co-design an intervention which will provide patients and families with a mechanism to address concerns which can be tested in practice.