Resuscitation 65 (2005) 329–336 Impact of a one-day inter-professional course (ALERTTM) on attitudes and confidence in managing critically ill adult patientsଝ Peter Featherstone a, b, Gary B. Smith b, c, ∗, Maggie Linnell d, Simon Easton d, Vicky M. Osgood b a Portsmouth Institute of Medicine, Health & Social Care, University of Portsmouth, UK b Portsmouth Hospitals NHS Trust, UK c Institute of Health & Community Studies, University of Bournemouth, UK d Department of Psychology, University of Portsmouth, UK Received 12 October 2004; accepted 10 December 2004 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 ALERTTM 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 ALERTTM 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 ALERTTM 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 ALERTTM course has beneficial effects on the confidence levels and attitudes of healthcare staff in relation to the recognition and management of acutely ill patients. © 2004 Elsevier Ireland Ltd. All rights reserved. Keywords: Education; Emergency treatment; Training 1. Introduction clinical deterioration and treatment is frequently delayed or inappropriate [1–5]. Poor management of the simple aspects Recent evidence suggests that some hospital patients re- of acute care, for example the management of the patient’s ceive sub-optimal ward care, resulting in potentially avoid- airway, breathing and circulation, oxygen therapy, fluid bal- able cardiac arrests, deaths and intensive care admissions ance and monitoring are often implicated. Failures of organ- [1–5]. Ward medical and nursing staff often miss signs of isation, 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. ଝ A Spanish and Portuguese translated version of the Abstract and Key- Similar concerns about acute care were reflected in the rec- words of this article appears at 10.1016/j.resuscitation.2004.12.011. ommendations of the UK Department of Health document ∗ Corresponding author. Present address: Department of Critical Care, “Comprehensive Critical Care” published in 2000 [7]. Queen Alexandra Hospital, Portsmouth PO6 3LY, UK. Tel.: +44 23 92286844; fax: +44 23 92286967. Anecdotal evidence and data from an unpublished local E-mail address: [email protected] (G.B. Smith). survey in Portsmouth also suggest that anxiety and lack of 0300-9572/$ – see front matter © 2004 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.resuscitation.2004.12.011 330 P. Featherstone et al. / Resuscitation 65 (2005) 329–336 confidence in managing acutely ill patients adversely af- 2.4. Procedure fects performance. In 1999, in response to local concerns, we designed a one-day inter-professional course in care of Individual questionnaires were returned by post for analy- the acutely ill adult patient—Acute Life-threatening Events, sis by the psychologists (ML and SE). The course developers Recognition and Treatment (ALERTTM) [8]—which is now (PF, GS and VO) and the local ALERTTM course organisers taught in more than 150 centres in the UK. were not involved in the data analysis and were, therefore, The educational objectives underpinning the design of the unaware of any individual’s responses. The psychologists had ALERTTM course include an improved knowledge of criti- not attended an ALERTTM course and were involved as inde- cal illness, better and earlier recognition and management of pendent assessors to help with the design, coding and analysis acutely ill patients, using a systematic plan of assessment, of the questionnaires. All respondents were asked to partici- enhanced inter-professional working patterns and communi- pate in a follow-up questionnaire and those who agreed were cation, including asking for senior help, and increased confi- sent one, 6 weeks after completing the ALERTTM course. dence when facing clinical emergencies. As part of ongoing These were again analysed by the psychologists. evaluation of the course, we wished to determine if and, if Questionnaires were analysed using an SPSS package. so, how ALERTTM had made an impact on staff attitudes to Pre- and post-test comparisons were made using related t- managing acutely ill patients. tests for ordinal data and chi-squared where the data was nominal. 2. Methods 3. Results A questionnaire (see Appendix A), based upon a series of piloted designs by the authors, was distributed to all partici- Of the 329 practitioners attending 23 different ALERTTM pants prior to their commencing one of 23 ALERTTM courses courses, 315 individuals handed in completed initial ques- held in the UK between August 2002 and January 2003. Data tionnaires, which were then passed on to the researchers. were collected on profession, age and sex of course partici- This sample consisted of 67 males and 244 females (four pants. did not specify). Six weeks later, a total of 131 (41.6% of ini- tial group) returned the second questionnaire (23 males, 107 2.1. Knowledge and experience (Q’s 1 and 2) females and 1 unknown). The professions of the respondents to both questionnaires are listed in Table 1. There was no An open-ended question assessed course attendee’s abil- significant difference in the ratio of male to female returners ity to recognise the signs of critical illness. In addition, the (χ2 = 1.96, n.s.), or in the distribution of returners and non- perceived extent of such knowledge and experience in that returners with regard to professional group (χ2 = 1.51, n.s.) domain was measured using a Likert scale. between the two questionnaires (Table 1). However, there was a significant difference between returners and non-returners 2.2. Confidence (Q’s 3–6) regarding age (χ2 = 12.01, p < 0.05), with respondents below the age of 30 being less likely to return the follow-up ques- An open-ended question assessed course attendee’s wor- tionnaire (Table 2). ries or concerns about their ability to recognise the signs of critical illness. Using Likert scales, perceived confidence was Table 1 then assessed in regard to: (a) being able to recognise the signs Professions of respondents to both questionnaires of a critically ill patient, (b) being able to keep that patient Professions Number of respondents Grade alive, (c) remember relevant life saving procedures. Atten- Pre-course Post-course dees were asked to rank a series of concerns and to comment Doctors 113 43 PRHO 18 on specific worries about being responsible for critically ill SHO 11 patients. Medical students 14 Nurses 180 80 C 1 2.3. Teamwork (Q’s 7 and 8) D23 E33 One question asked respondents which members of the F17 team they would approach for assistance after midnight. G6 Attitudes towards teamwork were then assessed with six Physiotherapists 15 6 Basic 1 questions measured on a 10 point Likert scale. The in- Senior I 2 Senior II 1 ternal reliability of the six questions relating to team- Superintendent 2 work was measured using Cronbach’s alpha [9] and the scores were then combined to produce an overall teamwork Other/no detail 7 2 Total 315 131 score. P. Featherstone et al. / Resuscitation 65 (2005) 329–336 331 Table 2 faced with managing acutely ill patients. In particular, par- Ages (in years) of respondents to initial and to both questionnaires, ticipants had greater confidence in their ability to recognise respectively when patients were critically ill, keep them alive and remem- Age (years) Non-returners Returners ber life saving procedures. They stated that they were also 20–29 106 54 more likely to use a systematic approach to their assessment. 30–39 37 36 After the course, participants felt that they had more knowl- 40–49 25 27 edge and appeared less worried about being responsible for 50–59 10 13 60+ 2 0 critically ill patients. Respondents also expressed improved No info 4 1 confidence in working as part of an interdisciplinary team when dealing with acutely ill adults, and more individuals were willing to approach senior members of staff after mid- After attending an ALERTTM course, respondents re- night to get help. ported significantly more knowledge (pre 5.47 ± 1.69, post This study was based on opportunistic sampling from in- 7.37 ± 1.22; p < 0.01) in recognising a critically ill patient.