Aim: The aim of this review was to identify and synthesise published accounts of recognising and responding to patient deterioration in the presence of deterioration antecedents. Design: The systematic review canvassed four electronic databases/ search engines for studies of adult ward patients who had altered physiological parameters before developing major adverse events. Synthesis Methods: The findings were synthesised using a narrative approach. Results: Clinical deterioration can be missed by nurses, even with adequate charting. Delays in recognising and responding to patient deterioration remains an international patient safety concern, and strategies to enhance recognition of patient deterioration have not achieved consistent improvements. The lack of significant and sustained improvement through targeted training suggests the problem may be rooted in human behaviour and local ward culture. Nurses play a pivotal role in recognising and responding to patient deterioration; however, patient records do not facilitate tracking of all nurse decisions and actions, and any undocumented care cannot be easily captured by auditing processes. Conclusion: Failure to recognise clinical deterioration was evident even with adequate charting. It is not clear if nurses do not recognise clinical deterioration because they failed to interpret the signs of deterioration or they made a conscious decision not to escalate based on their clinical judgement or they lacked attention at the time of the event. Whatever the reason, focus is warranted for nurses' decisionmaking after the recording of clinical deterioration signs and the role of human factors in delayed recognition, before maximum benefit of any strategy can be achieved.
Eye-tracking techniques have been adopted as a research tool for a wide range of applications in healthcare studies. Recently, healthcare researchers have started to show interest in using eye-tracking techniques to study medical decision-making. Mapping the literature pertaining to eye tracking using a systematic approach is valuable at this point to bring together all the studies to date on how medical decision-makers make decisions, and the results may contribute to clinical training. This review follows Arksey and O'Malley's scoping review framework to improve our understanding of visual cue processing in medical decision-making. A diverse range of studies was identified, and the results are presented descriptively to develop a more coherent understanding of different aspects of cue processing and errors in medical decision-making. The review shows the need for more extensive investigations of cue processing and medical decision-making. Crown Copyright (C) 2016 Published by Elsevier Ltd. All rights reserved.