Confidence in synthesised findings using the GRADE-CERQual framework
| Summary of review finding | Studies contributing to the finding | Methodological limitations | Coherence | Adequacy | Relevance | CERQual confidence assessment | Explanation of the CERQual evidence |
| Information packaging (using quantifiable evidence of patient deterioration) affected perceived communication credibility | 15 33–39 | Low concerns regarding study methodology | Low concerns about coherence | Low concerns about adequacy | Low concerns about relevance | High Confidence | All studies, demonstrated good methodology, data were considered moderately thick with high numbers of participants and methods, a high no of studies contributed to review finding, |
| Flattened hierarchy and were organisational components affecting escalation of care | 15 31 32 34 35 41–46 | Low concerns regarding methodology | Low concerns about coherence | Low concerns about adequacy | Low concerns about relevance | High Confidence | One study with minor concerns regarding methodology (survey), high no of studies contributing to finding, data were considered moderately thick with high numbers of participants and methods |
| Workload and staffing were factors considered by clinical staff to affect their Situational awareness of patient deterioration. | 15 32 34–36 41 42 45 47–52 | Minor concerns regarding methodology | Low concerns about coherence | Low concerns about adequacy | Low concerns about relevance | High confidence | Two studies with minor methodological concerns with one study where using a survey, and another study using participants for a focus group put forward by head nurse, high no of studies contributing to review finding, rich data sources and multiple methods of data collection, data were considered moderately thick with high numbers of participants and methods |
| Team functioning caused problems or facilitated care during escalation | 15 32 33 35 36 41–45 47–51 | Minor concerns regarding methodology | Low concerns about coherence | Low concerns about adequacy | Low concerns about relevance | High confidence | Two studies with methodological concerns, one study where using a survey, and another study using participants for a focus group put forward by head nurse, all other studies demonstrate good methodology, high no of studies contributing to review finding, data were considered moderately thick with high numbers of participants and methods |
| Soft signal of patient deterioration used by clinical staff indicating a patient’s worsening condition, not adequately represented in Early Warning Score | 15 31 33 35 36 38 41 42 44 46 49–51 54–56 | Moderate concerns regarding methodology | Low concerns about coherence | Moderate concerns about adequacy | Low concerns about relevance | Moderate Confidence | Three studies had methodological concerns. One utilising a survey methodology with open ended-questions, the other was being observed by the implementer of the local Medical Emergency Team (MET), the last one using participants for a focus group put forward by head nurse, large no of studies contributing to synthesis finding, |
| Clinician confidence affected decision making during escalation of care | 31–36 38 43–45 47 49–52 55 | Moderate concerns about methodology | Low concerns about coherence | Moderate concerns about adequacy | Low concerns about relevance | Moderate confidence | Four studies had methodological concerns, two studies utilised a survey methodology with open ended-questions, the other study had a focus group where participants were selected by head nurse, the other had observation completed by the implementer of the local RRT, data were considered moderately thick with high numbers of participants and different methods, large no of studies contributing to synthesis finding |
| Clinical Assessment skills relating to patient assessment and staff experience positively or negatively affected deterioration detection by clinical staff | 15 35 36 38 42 43 46 49–51 54 55 | Moderate concerns regarding methodology | Low concerns about coherence | Moderate concerns about adequacy | Low concerns about relevance | Moderate Confidence | Two studies with methodological concerns. One had observations completed by the implementer of the local RRT, the other study had a focus group where participants were selected by head nurse, data were considered moderately thick |
GRADE, Grading of Recommendations Assessment, Development and Evaluation; RRT, rapid response ream.