{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T06:47:51Z","timestamp":1790318871387,"version":"4.1.0"},"reference-count":56,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2019,12,1]],"date-time":"2019-12-01T00:00:00Z","timestamp":1575158400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2019,12,30]],"date-time":"2019-12-30T00:00:00Z","timestamp":1577664000000},"content-version":"vor","delay-in-days":29,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"The South African National Research Foundation","award":["Grant No. 90295"],"award-info":[{"award-number":["Grant No. 90295"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Trials"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Nurses\u2019 recognition of clinical deterioration is crucial for patient survival. Evidence for the effectiveness of modified early warning scores (MEWS) is derived from large observation studies in developed countries.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We tested the effectiveness of the paper-based Cape Town (CT) MEWS vital signs observation chart and situation-background-assessment-recommendation (SBAR) communication guide. Outcomes were: proportion of appropriate responses to deterioration, differences in recording of clinical parameters and serious adverse events (SAEs) in intervention and control trial arms. Public teaching hospitals for adult patients in Cape Town were randomised to implementation of the CT MEWS\/SBAR guide or usual care (observation chart without track-and-trigger information) for 31\u2009days on general medical and surgical wards. Nurses in intervention wards received training, as they had no prior knowledge of early warning systems. Identification and reporting of patient deterioration in intervention and control wards were compared. In the intervention arm, 24\u2009day-shift and 23 night-shift nurses received training. Clinical records were reviewed retrospectively at trial end. Only records of patients who had given signed consent were reviewed.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>We recruited two of six CT general hospitals. We consented 363 patients and analysed 292 (80.4%) patient records (<jats:italic>n<\/jats:italic>\u00a0=\u2009150, 51.4% intervention, <jats:italic>n<\/jats:italic>\u00a0=\u2009142, 48.6% control arm). Assistance was summoned for fewer patients with abnormal vital signs in the intervention arm (2\/45, 4.4% versus (vs) 11\/81, 13.6%, OR 0.29 (0.06\u20131.39)), particularly low systolic blood pressure. There was a significant difference in recording between trial arms for parameters listed on the MEWS chart but omitted from the standard observations chart: oxygen saturation, level of consciousness, pallor\/cyanosis, pain, sweating, wound oozing, pedal pulses, glucose concentration, haemoglobin concentration, and \u201clooks unwell\u201d. SBAR was used twice. There was no statistically significant difference in SAEs (5\/150, 3.3% vs 3\/143, 2.1% <jats:italic>P<\/jats:italic>\u00a0=\u20090.72, OR 1.61 (0.38\u20136.86)).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>The revised CT MEWS observations chart improved recording of certain parameters, but did not improve nurses\u2019 ability to identify early signs of clinical deterioration and to summon assistance. Recruitment of only two hospitals and exclusion of patients too ill to consent limits generalisation of results. Further work is needed on educational preparation for the CT MEWS\/SBAR and its impact on nurses\u2019 reporting behaviour.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Trial registration<\/jats:title>\n                <jats:p>Pan African Clinical Trials Registry, <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/pactr.samrc.ac.za\/Search.aspx\">PACTR201406000838118<\/jats:ext-link>. Registered on 2 June 2014, <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.pactr.org\">www.pactr.org<\/jats:ext-link>.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13063-019-3916-0","type":"journal-article","created":{"date-parts":[[2019,12,30]],"date-time":"2019-12-30T22:02:51Z","timestamp":1577743371000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Testing effectiveness of the revised Cape Town modified early warning and SBAR systems: a pilot pragmatic parallel group randomised controlled trial"],"prefix":"10.1186","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1611-8014","authenticated-orcid":false,"given":"Una","family":"Kyriacos","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debora","family":"Burger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sue","family":"Jordan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2019,12,30]]},"reference":[{"key":"3916_CR1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0087073","volume":"9","author":"U Kyriacos","year":"2014","unstructured":"Kyriacos U, Jelsma J, James M, Jordan S. Monitoring vital signs: development of a modified early warning scoring (Mews) system for general wards in a developing country. PLoS One. 2014;9:e87073.","journal-title":"PLoS One"},{"issue":"1","key":"3916_CR2","doi-asserted-by":"publisher","first-page":"e87320","DOI":"10.1371\/journal.pone.0087320","volume":"9","author":"Una Kyriacos","year":"2014","unstructured":"Kyriacos U, Jelsma J, Jordan S. Record review to explore the adequacy of post-operative vital signs monitoring using a local modified early warning score (Mews) chart to evaluate outcomes. PLoS One. 2014;9:e87320.","journal-title":"PLoS ONE"},{"key":"3916_CR3","doi-asserted-by":"crossref","unstructured":"Kyriacos U, Jelsma J, James M, Jordan S. Early warning scoring systems versus standard observations charts for wards in South Africa: a cluster randomized controlled trial. Trials. 2015;16:103.","DOI":"10.1186\/s13063-015-0624-2"},{"issue":"5","key":"3916_CR4","doi-asserted-by":"publisher","first-page":"e47","DOI":"10.1136\/qshc.2008.031807","volume":"19","author":"G. Robb","year":"2010","unstructured":"Robb G, Seddon M. A multi-faceted approach to the physiologically unstable patient. Qual Saf Health Care. 2010;19:e47.","journal-title":"BMJ Quality & Safety"},{"key":"3916_CR5","doi-asserted-by":"publisher","first-page":"1192","DOI":"10.1016\/j.resuscitation.2013.03.016","volume":"84","author":"K De Meester","year":"2013","unstructured":"De Meester K, Verspuy M, Monsieurs KG, Van Bogaert P. SBAR improves nurse\u2013physician communication and reduces unexpected death: a pre and post intervention study. Resuscitation. 2013;84:1192\u20136.","journal-title":"Resuscitation"},{"key":"3916_CR6","doi-asserted-by":"publisher","first-page":"1428","DOI":"10.1016\/j.resuscitation.2011.05.026","volume":"82","author":"J Ludikhuize","year":"2011","unstructured":"Ludikhuize J, de Jonge E, Goossens A. Measuring adherence among nurses one year after training in applying the modified early warning score and situation-background-assessment-recommendation instruments. Resuscitation. 2011;82:1428\u201333.","journal-title":"Resuscitation"},{"key":"3916_CR7","doi-asserted-by":"publisher","first-page":"790","DOI":"10.1016\/j.trstmh.2009.05.004","volume":"103","author":"J Rylance","year":"2009","unstructured":"Rylance J, Baker T, Mushi E, Mashaga D. Use of an early warning score and ability to walk predicts mortality in medical patients admitted to hospitals in Tanzania. Trans R SocTrop Med Hyg. 2009;103:790\u20134.","journal-title":"Trans R SocTrop Med Hyg"},{"key":"3916_CR8","doi-asserted-by":"publisher","first-page":"717","DOI":"10.1093\/jamia\/ocw186","volume":"24","author":"D Wong","year":"2017","unstructured":"Wong D, Bonnici T, Knight J, Gerry S, Turton J, Watkinson P. A ward-based time study of paper and electronic documentation for recording vital sign observations. J Am Med Inform Assoc. 2017;24:717\u201321.","journal-title":"J Am Med Inform Assoc"},{"key":"3916_CR9","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1097\/CIN.0000000000000305","volume":"35","author":"G Sefton","year":"2017","unstructured":"Sefton G, Lane S, Killen R, Black S, Lyon M, Ampah P, Sproule C, Loren-Gosling D, Richards C, Spinty J, et al. Accuracy and efficiency of recording pediatric early warning scores using an electronic physiological surveillance system compared with traditional paper-based documentation. Comput Inform Nurs. 2017;35:228\u201336.","journal-title":"Comput Inform Nurs"},{"key":"3916_CR10","doi-asserted-by":"publisher","first-page":"18","DOI":"10.12968\/bjon.2009.18.1.32072","volume":"18","author":"M Mohammed","year":"2009","unstructured":"Mohammed M, Hayton R, Clements G, Smith G, Prytherch D. Improving accuracy and efficiency of early warning scores in acute care. Br J Nurs. 2009;18:18\u201324.","journal-title":"Br J Nurs"},{"key":"3916_CR11","volume-title":"Report of a working party","author":"Royal College of Physicians","year":"2012","unstructured":"Royal College of Physicians. National early warning score (NEWS): standardising the assessment of acute-illness severity in the NHS. In: Report of a working party. London: Royal College of Physicians; 2012."},{"key":"3916_CR12","doi-asserted-by":"publisher","first-page":"797","DOI":"10.1046\/j.1365-2044.2003.03258.x","volume":"58","author":"CP Subbe","year":"2003","unstructured":"Subbe CP, Davies RG, Williams E, Rutherford P, Gemmell L. Effect of introducing the modified early warning score on clinical outcomes, cardio-pulmonary arrests and intensive care utilisation in acute medical admissions. Anaesthesia. 2003;58:797\u2013802.","journal-title":"Anaesthesia"},{"key":"3916_CR13","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1016\/j.nedt.2016.06.001","volume":"44","author":"CJ Connell","year":"2016","unstructured":"Connell CJ, Endacott R, Jackman JA, Kiprillis NR, Sparkes LM, Cooper SJ. The effectiveness of education in the recognition and management of deteriorating patients: a systematic review. Nurse Educ Today. 2016;44:133\u201345.","journal-title":"Nurse Educ Today"},{"key":"3916_CR14","doi-asserted-by":"publisher","first-page":"2506","DOI":"10.1111\/jan.13322","volume":"73","author":"MM Saab","year":"2017","unstructured":"Saab MM, McCarthy B, Andrews T, Savage E, Drummond FJ, Walshe N, Forde M, Breen D, Henn P, Drennan J, Hegarty J. The effect of adult early warning systems education on nurses\u2019 knowledge, confidence and clinical performance: a systematic review. J Adv Nurs. 2017;73:2506\u201321.","journal-title":"J Adv Nurs"},{"key":"3916_CR15","unstructured":"National Health Insurance Bill. In Government Gazette No. 42598 of 26 July. ISBN 978\u20131\u20134850-0609-1; 2019. Retrieved from: https:\/\/www.gov.za\/sites\/default\/files\/gcis_document\/201908\/national-health-insurance-bill-b-11-2019.pdf. Accessed 6 Dec 2019."},{"key":"3916_CR16","doi-asserted-by":"publisher","first-page":"436","DOI":"10.1177\/1740774515598334","volume":"12","author":"RM Califf","year":"2015","unstructured":"Califf RM, Sugarman J. Exploring the ethical and regulatory issues in pragmatic clinical trials. Clin Trials. 2015;12:436\u201341.","journal-title":"Clin Trials"},{"key":"3916_CR17","doi-asserted-by":"publisher","first-page":"442","DOI":"10.1177\/1740774515597699","volume":"12","author":"DM Whicher","year":"2015","unstructured":"Whicher DM, Miller JE, Dunham KM, Joffe S. Gatekeepers for pragmatic clinical trials. Clin Trials. 2015;12:442\u20138.","journal-title":"Clin Trials"},{"key":"3916_CR18","doi-asserted-by":"publisher","first-page":"485","DOI":"10.1177\/1740774515597687","volume":"12","author":"JD Lantos","year":"2015","unstructured":"Lantos JD, Wendler D, Septimus E, Wahba S, Madigan R, Bliss G. Considerations in the evaluation and determination of minimal risk in pragmatic clinical trials. Clin Trials. 2015;12:485\u201393.","journal-title":"Clin Trials"},{"key":"3916_CR19","unstructured":"ICH Harmonised Tripartite Guideline for Good Clinical Practice. J Postgrad Med. 2001;47:199\u2013203."},{"key":"3916_CR20","unstructured":"SISA-binomial (simple interactive statistical analysis) [http:\/\/www.quantitativeskills.com\/sisa\/calculations\/sampshlp.htm]. Accessed 6 Dec 2019."},{"key":"3916_CR21","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1370\/afm.141","volume":"2","author":"S Killip","year":"2004","unstructured":"Killip S, Mahfoud Z, Pearce K. What Is an Intracluster Correlation Coefficient? Crucial Concepts for Primary Care Researchers. Ann Fam Med. 2004;2:204\u20138.","journal-title":"Ann Fam Med"},{"key":"3916_CR22","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e1119","volume":"344","author":"A Hrobjartsson","year":"2012","unstructured":"Hrobjartsson A, Thomsen AS, Emanuelsson F, Tendal B, Hilden J, Boutron I, Ravaud P, Brorson S. Observer bias in randomised clinical trials with binary outcomes: systematic review of trials with both blinded and non-blinded outcome assessors. Bmj. 2012;344:e1119.","journal-title":"Bmj"},{"key":"3916_CR23","volume-title":"Requirements for certification of ECRIN data centres with explanation and elaboration of standards","author":"European Clinical Research Infrastructure Network (ECRIN)","year":"2018","unstructured":"European Clinical Research Infrastructure Network (ECRIN) In Requirements for certification of ECRIN data centres with explanation and elaboration of standards; 2018."},{"key":"3916_CR24","doi-asserted-by":"publisher","first-page":"1223","DOI":"10.1136\/bmj.a2390","volume":"337","author":"M Zwarenstein","year":"2008","unstructured":"Zwarenstein M, Treweek S, Gagnier J, Altman D, Tunis S, Haynes B, Oxman A, Moher D. Improving the reporting of pragmatic trials: an extension of the CONSORT statement. BMJ. 2008;337:1223\u20136.","journal-title":"BMJ"},{"key":"3916_CR25","volume-title":"Practical Statistics for Medical Research","author":"D Altman","year":"1991","unstructured":"Altman D. Practical Statistics for Medical Research. London: Chapman & Hall; 1991."},{"key":"3916_CR26","doi-asserted-by":"publisher","first-page":"1147","DOI":"10.1016\/j.jclinepi.2003.05.003","volume":"57","author":"KJ Ottenbacher","year":"2004","unstructured":"Ottenbacher KJ, Ottenbacher HR, Tooth L, Ostir GV. A review of two journals found that articles using multivariable logistic regression frequently did not report commonly recommended assumptions. J Clin Epidemiol. 2004;57:1147\u201352.","journal-title":"J Clin Epidemiol"},{"key":"3916_CR27","unstructured":"New manuscripts, reporting guidelines [https:\/\/www.nejm.org\/author-center\/new-manuscripts]. Accessed 6 Dec 2019."},{"key":"3916_CR28","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0161393","volume":"11","author":"LS van Galen","year":"2016","unstructured":"van Galen LS, Struik PW, Driesen BE, Merten H, Ludikhuize J, van der Spoel JI, Kramer MH, Nanayakkara PW. Delayed recognition of deterioration of patients in general wards is mostly caused by human related monitoring failures: a root cause analysis of unplanned ICU admissions. PLoS One. 2016;11:e0161393.","journal-title":"PLoS One"},{"key":"3916_CR29","first-page":"1","volume":"65","author":"JA Petersen","year":"2018","unstructured":"Petersen JA. Early warning score. Challenges and opportunities in the care of deteriorating patients. Dan Med J. 2018;65:1\u201313.","journal-title":"Dan Med J"},{"key":"3916_CR30","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1016\/j.jcrc.2017.12.020","volume":"44","author":"M Brabrand","year":"2018","unstructured":"Brabrand M, Hallas P, Folkestad L, Lautrup-Larsen CH, Brodersen JB. Measurement of respiratory rate by multiple raters in a clinical setting is unreliable: a cross-sectional simulation study. J Crit Care. 2018;44:404\u20136.","journal-title":"J Crit Care"},{"key":"3916_CR31","doi-asserted-by":"publisher","first-page":"820","DOI":"10.1177\/0310057X1204000510","volume":"40","author":"Y Nonose","year":"2012","unstructured":"Nonose Y, Sato Y, Kabayama H, Arisawa A, Onodera M, Imanaka H, Nishimura M. Accuracy of recorded body temperature of critically ill patients related to measurement site: a prospective observational study. Anaesth Intensive Care. 2012;40:820\u20134.","journal-title":"Anaesth Intensive Care"},{"key":"3916_CR32","first-page":"898","volume":"48","author":"V Singh","year":"2000","unstructured":"Singh V, Sharma A, Khandelwal R, Kothari K. Variation of axillary temperature and its correlation with oral temperature. J Assoc Physicians India. 2000;48:898\u2013900.","journal-title":"J Assoc Physicians India"},{"key":"3916_CR33","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1046\/j.1365-2648.2000.01414.x","volume":"32","author":"J Cioffi","year":"2000","unstructured":"Cioffi J. Nurses\u2019 experiences of making decisions to call emergency assistance to their patients. J Adv Nurs. 2000;32:108\u201314.","journal-title":"J Adv Nurs"},{"key":"3916_CR34","doi-asserted-by":"publisher","first-page":"iii","DOI":"10.3310\/hta11430","volume":"11","author":"M Keogh-Brown","year":"2007","unstructured":"Keogh-Brown M, Bachmann M, Shepstone L, Hewitt C, Howe A, Ramsay C. Contamination in trials of educational interventions. Health Technol Assess. 2007;11:iii.","journal-title":"Health Technol Assess"},{"key":"3916_CR35","volume-title":"Cochrane handbook for systematic reviews of interventions Version 5.1.0 edition","author":"JPT Higgins","year":"2011","unstructured":"Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions Version 5.1.0 edition; 2011."},{"key":"3916_CR36","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1046\/j.1365-2648.2000.01279.x","volume":"31","author":"S Jordan","year":"2000","unstructured":"Jordan S. Educational input and patient outcomes: exploring the gap. J Adv Nurs. 2000;31:461\u201371.","journal-title":"J Adv Nurs"},{"key":"3916_CR37","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1016\/j.resuscitation.2004.12.011","volume":"65","author":"P Featherstone","year":"2005","unstructured":"Featherstone P, Smith GB, Linnell M, Easton S, Osgood VM. Impact of a one-day inter-professional course (ALERT) on attitudes and confidence in managing critically ill adult patients. Resuscitation. 2005;65:329\u201336.","journal-title":"Resuscitation"},{"key":"3916_CR38","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1111\/j.1478-5153.2006.00195.x","volume":"12","author":"L Tume","year":"2007","unstructured":"Tume L. The deterioration of children in ward areas in a specialist children's hospital. Nurs Crit Care. 2007;12:12\u20139.","journal-title":"Nurs Crit Care"},{"key":"3916_CR39","doi-asserted-by":"publisher","first-page":"1357","DOI":"10.1016\/j.resuscitation.2009.07.002","volume":"80","author":"L Fuhrmann","year":"2009","unstructured":"Fuhrmann L, Perner A, Klausen TW, Ostergaard D, Lippert A. The effect of multi-professional education on the recognition and outcome of patients at risk on general wards. Resuscitation. 2009;80:1357\u201360.","journal-title":"Resuscitation"},{"key":"3916_CR40","doi-asserted-by":"publisher","first-page":"295","DOI":"10.7326\/0003-4819-148-4-200802190-00008","volume":"148","author":"I Boutron","year":"2008","unstructured":"Boutron I, Moher D, Altman D, Schulz K, Ravaud P. Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Ann Intern Med. 2008;148:295\u2013309.","journal-title":"Ann Intern Med"},{"key":"3916_CR41","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001346","volume":"9","author":"C Weijer","year":"2012","unstructured":"Weijer C, Grimshaw JM, Eccles MP, McRae AD, White A, Brehaut JC, Taljaard M. The Ottawa statement on the ethical design and conduct of cluster randomized trials. PLoS Med. 2012;9:e1001346.","journal-title":"PLoS Med"},{"key":"3916_CR42","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2013-003057","volume":"3","author":"K DiazOrdaz","year":"2013","unstructured":"DiazOrdaz K, Slowther A-M, Potter R, Eldridge S. Consent processes in cluster-randomised trials in residential facilities for older adults: a systematic review of reporting practices and proposed guidelines. BMJ Open. 2013;3:e003057.","journal-title":"BMJ Open"},{"issue":"may09 1","key":"3916_CR43","doi-asserted-by":"publisher","first-page":"f2838","DOI":"10.1136\/bmj.f2838","volume":"346","author":"M. Taljaard","year":"2013","unstructured":"Taljaard M, Weijer C, Grimshaw JM, Eccles MP. The Ottawa statement on the ethical design and conduct of cluster randomised trials: pr\u00e9cis for researchers and research ethics committees. BMJ. 2013;346:f2838.","journal-title":"BMJ"},{"key":"3916_CR44","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1111\/anae.13709","volume":"72","author":"PJ Dart","year":"2017","unstructured":"Dart PJ, Kinnear J, Bould MD, Mwansa SL, Rakhda Z, Snell D. An evaluation of inpatient morbidity and critical care provision in Zambia. Anaesthesia. 2017;72:172\u201380.","journal-title":"Anaesthesia"},{"key":"3916_CR45","doi-asserted-by":"publisher","first-page":"1987","DOI":"10.1001\/jama.288.16.1987","volume":"288","author":"L Aiken","year":"2002","unstructured":"Aiken L, Clarke S, Sloane D, Sochalski J, Silber J. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA. 2002;288:1987\u201393.","journal-title":"JAMA"},{"key":"3916_CR46","doi-asserted-by":"publisher","first-page":"1617","DOI":"10.1001\/jama.290.12.1617","volume":"290","author":"LH Aiken","year":"2003","unstructured":"Aiken LH, Clarke SP, Cheung RB, Sloane DM, Silber JH. Educational levels of hospital nurses and surgical patient mortality. JAMA. 2003;290:1617\u201323.","journal-title":"JAMA"},{"key":"3916_CR47","doi-asserted-by":"publisher","first-page":"1150","DOI":"10.1111\/jan.13517","volume":"74","author":"KA Burns","year":"2018","unstructured":"Burns KA, Reber T, Theodore K, Welch B, Roy D, Siedlecki SL. Enhanced early warning system impact on nursing practice: a phenomenological study. J Adv Nurs. 2018;74:1150\u20136.","journal-title":"J Adv Nurs"},{"issue":"2","key":"3916_CR48","doi-asserted-by":"publisher","first-page":"e0118253","DOI":"10.1371\/journal.pone.0118253","volume":"10","author":"Baris A. Ozdemir","year":"2015","unstructured":"Ozdemir B, Karthikesalingam A, Sinha S, Poloniecki J, Hinchliffe R, Thompson M, Gower J, Boaz A, Holt P. Research activity and the association with mortality. PLoS One. 2015;10:e0118253.","journal-title":"PLOS ONE"},{"key":"3916_CR49","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0067912","volume":"8","author":"S Jordan","year":"2013","unstructured":"Jordan S, Watkins A, Storey M, Allen S, Brooks C, Garaiova I, Heaven M, Jones R, Plummer S, Russell I, et al. Volunteer bias in recruitment, retention, and blood sample donation in a randomised controlled trial involving mothers and their children at six months and two years: a longitudinal analysis. PLoS One. 2013;8:e67912.","journal-title":"PLoS One"},{"key":"3916_CR50","first-page":"19","volume":"345","author":"M Campbell","year":"2012","unstructured":"Campbell M, Piaggio G, Elbourne D, Altman D. Consort 2010 statement: extension to cluster randomised trials. BMJ. 2012;345:19.","journal-title":"BMJ"},{"key":"3916_CR51","doi-asserted-by":"publisher","first-page":"115","DOI":"10.2466\/pr0.1966.19.1.115","volume":"19","author":"R Rosenthal","year":"1963","unstructured":"Rosenthal R, Jacobson L. Teachers\u2019 expectancies: determinants of pupils\u2019 IQ gains. Psychol Rep. 1963;19:115\u20138.","journal-title":"Psychol Rep"},{"key":"3916_CR52","volume-title":"Clinical epidemiology: a basic science for clinical medicine","author":"D Sackett","year":"1991","unstructured":"Sackett D, Haynes R, Guyatt G, Tugwell P. Clinical epidemiology: a basic science for clinical medicine. 2nd ed. Boston: Little, Brown; 1991.","edition":"2"},{"key":"3916_CR53","volume-title":"The Lancet handbook of essential concepts in clinical research","author":"K Schulz","year":"2006","unstructured":"Schulz K, Grimes D. The Lancet handbook of essential concepts in clinical research. Edinburgh: Elsevier; 2006."},{"key":"3916_CR54","doi-asserted-by":"publisher","first-page":"11","DOI":"10.4102\/curationis.v32i2.915","volume":"32","author":"J McIntosh","year":"2009","unstructured":"McIntosh J, Stellenberg E. Effect of a staffing strategy based on voluntary increase in working hours on quality of patient care in a hospital in KwaZulu-Natal. Curationis. 2009;32:11\u201320.","journal-title":"Curationis"},{"key":"3916_CR55","volume-title":"Management and the worker","author":"F Roethlisberger","year":"1939","unstructured":"Roethlisberger F, Dickson W. Management and the worker. Cambridge: Harvard University Press; 1939."},{"key":"3916_CR56","volume-title":"Institute of Medicine (US). Roundtable on evidence-based medicine. the learning healthcare system: workshop summary","author":"L Olsen","year":"2007","unstructured":"Olsen L, Aisner D, McGinnis JM. Institute of Medicine (US). Roundtable on evidence-based medicine. the learning healthcare system: workshop summary. Washington, DC: National Academies Press; 2007."}],"container-title":["Trials"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s13063-019-3916-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s13063-019-3916-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s13063-019-3916-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,12,29]],"date-time":"2020-12-29T00:27:30Z","timestamp":1609201650000},"score":1,"resource":{"primary":{"URL":"https:\/\/trialsjournal.biomedcentral.com\/articles\/10.1186\/s13063-019-3916-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,12]]},"references-count":56,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2019,12]]}},"alternative-id":["3916"],"URL":"https:\/\/doi.org\/10.1186\/s13063-019-3916-0","relation":{},"ISSN":["1745-6215"],"issn-type":[{"value":"1745-6215","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,12]]},"assertion":[{"value":"4 February 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 November 2019","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 December 2019","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The study received ethical approval from the Local University of Cape Town Human Research Ethics Committee (HREC ref. 337\/2014; HREC ref. 825\/2014), the local Provincial Department of Health (ref. 2014RP069) and the National Department of Health. The trial sponsor was the local CRC, UCT. Permissions from hospital gatekeepers were obtained.Written consent was obtained from participants (patients for record review following the intervention and nurses for training and record review (intervention wards) and nurses for record review and no training (control wards).","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"809"}}