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How human factors affect escalation of care: a protocol for a qualitative evidence synthesis of studies

“…Studies must report primary data and describe human factors affecting failure to rescue and escalation of care. Failure to rescue is defined as patient mortality following complications1 and escalation of care is a staged process where patients are identified as ‘deteriorating’, and that deterioration is then communicated followed by senior review and medical intervention where necessary 4. We will include any qualitative study which explores the perspective of patients or clinical staff (adults or paediatric) and the human factors which affect the escalation of care process.…”

“…A proportion of severe harm and patient deaths (32%) reported to the National Patient Safety Agency had failures surrounding diagnostic errors and deteriorations which were not adequately recognised 3. Failure to recognise the need to rescue patients by providing timely escalation of care is a finding in several national reports such as National Confidential Enquiry into Patient Outcomes and Death (NCEPOD)4–7 and National Institute for Health and Care Excellence CG 50 8…”

“…For ‘failure to rescue’ to be avoided, bedside clinical staff must usually initiate successful escalation of care 9. This staged process requires detection of deterioration, communication about deterioration and actions following senior review 4. Many factors affect this process such as situational awareness, team working, communication, safety culture and leadership 4 10–14.…”

“…This staged process requires detection of deterioration, communication about deterioration and actions following senior review 4. Many factors affect this process such as situational awareness, team working, communication, safety culture and leadership 4 10–14. Understanding these human factors is essential to developing working systems that mitigate barriers and facilitate prompt escalation of care.…”