Tentative initial programme theories
| IPT | If | Then | Outcome |
| 1 | If ward staff have the knowledge and clinical skills to assess the early warning signs of MSD and manage risks early using diversional activities as the first level of escalation. | Then, this would likely reduce the probability of an RRS response. | Because any intervention designed to manage MSD will be most effective when implemented early in the sequence of deterioration and containment events. |
| 2 | If wards staff have the knowledge and clinical skills to use clinical risk assessment tools to assess, monitor and escalate changes in a patient’s mental state. | Then this would lead to the timely activation of an RRS, effectively managing risk from escalating. | Because there needs to be consistent clinical practice from ward staff for the RRS to be effective in managing MSD and to reduce the incidences of code grey and improvement in clinical care. |
| 3 | If the RRS collaboratively manages patients presenting with MSD with the staff on the ward. | Then the ward staff would learn and gain clinical skills from the RRS to respond effectively to and manage MSD presentations and build the ability and resiliency by developing resources to manage mental deterioration presentations. | Because resilient staff are more likely to have the confidence to assess, escalate and manage MSD. |
| 4 | If ward staff have access to evidence-based risk assessment tools for monitoring early warning signs of MSD. | Then this would prompt timely intervention through a rapid response if the tools indicate a likely escalation of risks. | This is because the staff’s ability to recognise, assess and escalate MSD needs to be based on validated tools leading to consistency in clinical practice. |
| 5 | If indicators of MSD are audited to monitor the scale, nature and characteristics of the prevalence of RRS and code grey incidence. | Then that would improve understanding of the patient, staff and organisational needs. | Because it is critical to determine the effectiveness of the RRS intervention in managing MSD and reducing code grey incidences to inform future strategies. |
| 6 | If, through the RRS, dedicated mental health trained staff with experience in the management of patients to respond and manage MSD presentations in acute hospital settings. | Then, the RRS would facilitate, (1) specialist experience from diagnosis, review and recommendations of the treatment plan, pharmacological management, to the behavioural management plan for patients with MSD in medical wards; (2) building the capacity of staff and confidence in MSD through communication by handover from the RRS, documentation of the care plan in clinical notes and handovers of the wards for monitoring and escalation plans. | Because mental health staff have experience managing mental health presentations, their valuable experience is essential for the effectiveness of the RRS in improving outcome for patients. |
| 7 | If clear, supportive, relevant and consistent RRS guidelines are in place for managing MSD, that acute hospital setting staff can easily access. | Then, guidelines would clarify roles and responsibilities of team members, specify communication procedures, outline intervention expectations, and follow-up care and documentation procedures. | Because guidelines and policies are part of a comprehensive, multifaceted system that must be in place for the effectiveness of the RRS intervention as an early intervention for the management of MSD. Guidelines lead to a more organised, responsive and supportive framework for managing mental state deterioration, leading to better outcomes for patients and the effectiveness of the response team. |
| 8 | If the organisation regularly collects MSD data for clinical governance purposes. | Then the data collection systems must be intuitive and easy to navigate, avoid replication and balance demands of a busy ward and data reporting requirements. | Because the collection of high-quality data is critical for evaluating interventions and ensuring that the organisation delivers high-quality care, minimises risks and remains responsive to the evolving needs of patients. |
IPT, initial programme theory; MSD, mental state deterioration; RRS, rapid response system.