Life In The Slower Lane

Here is the structured PICO analysis for the eleventh article you uploaded:

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Full Title (verbatim and exact):

“Recognising and responding to acute deterioration in care home residents: a scoping review”

Hodge SY, Ali MR, Hui A, Logan P, Gordon AL

BMC Geriatrics 2023; 23:399

DOI: https://doi.org/10.1186/s12877-023-04082-y

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Type of Article:

Scoping review (Joanna Briggs Institute methodology)

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PICO Analysis:

Population:

• Care home residents aged ≥65 years
• The study focused on long-term care facilities (with or without nursing) providing 24/7 care
• 11 included studies involved care home staff (e.g. Registered Nurses [RNs], Enrolled Nurses [ENs], Personal Care Assistants [PCAs]) from Australia, the UK, the USA, South Korea, and Singapore 

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Intervention:

• Recognition and response practices for acute deterioration in residents
• Interventions included:
  • Informal practices such as knowing the resident, gut feeling, and intuitive recognition
  • Implementation of hospital-derived tools such as the National Early Warning Score (NEWS)
  • Access to Residential InReach (RiR) sub-acute services (e.g. nurse-led or geriatrician teams)
  • Use of hospital avoidance programmes
  • Rare use of formal protocols for deterioration management

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Comparator:

• No formal comparator group
• Variability explored across different care home settings, staff roles, presence or absence of structured protocols, and access to external services

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Outcome:

1. Person-centred outcomes:

• Not directly assessed; however, outcomes such as resident stability, hospital transfers, and family satisfactionwere discussed indirectly
• Staff aimed to avoid hospitalisation due to concern about the trauma and poor outcomes associated with hospital admissions for frail residents 

2. Process outcomes:

• Descriptive outcomes included:
  • Recognition often depended on care staff familiarity with residents rather than structured clinical tools
  • Escalation pathways varied, often governed by internal hierarchy and fear of litigation
  • Staff lacked confidence in their autonomy and often deferred to external healthcare providers 

3. Health system outcomes:

• Hospital transfers were often the default outcome in the absence of support or confidence
• Fear of legal consequences led to over-referral and loss of clinical autonomy
• Lack of consistency and support services across regions was a key barrier to managing deterioration on-site
• Evidence for effectiveness of NEWS tools in care homes was limited and inconclusive, despite widespread policy-driven implementation 

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Summary Conclusion:

This scoping review revealed that recognition and response to acute deterioration in care home residents is highly contextual, often reliant on intuitive recognition by familiar staff rather than structured tools. Formal protocols are rare, and hierarchical barriers, staffing pressures, and limited external support services influence escalation decisions. Hospital transfer is frequently the outcome due to risk-aversion and lack of resources. The review identifies a critical evidence gap around validated deterioration management pathways for aged care settings, underscoring the need for context-specific tools and infrastructure to support safe in-place care.

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