Aetiology of hospital setting adverse events 2: ‘clinical futile cycles’

Buist, Michael; Middleton, Sarah

doi:10.12968/hmed.2016.77.11.c175

Cited by 3 publications

(5 citation statements)

References 17 publications

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“…Without precise daily capture and registration of clinical AEs of all categories of severity, and without regular epidemiological analysis and assessment of clinical AEs, a reduction of incidence and, subsequently, the burden of AEs resulting from medical treatment may be hardly achievable. Furthermore, as Buist and Middleton have recently suggested, entirely new concepts to better understand and manage more complex hospital setting AEs with the aim of designing interventions that are more focused on a hospital’s core business are needed [ 23 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…This study also implies that additional efforts are necessary to make the medical interventions safer for two marginal age groups of individuals—neonatal and elderly—in order to meet the demand generated by the growing number of the populations from these age groups in the UK [ 25 , 26 ]. Finally, comparisons of ASMR within the set of 33 high-income countries and the modest (the 15 th ) ranking of the UK suggest that it is time to reconsider key points concerning the interaction between the patient and the healthcare professional [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

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Incidence and mortality from adverse effects of medical treatment in the UK, 1990–2013: levels, trends, patterns and comparisons

Lunevičius

Haagsma

2018

International Journal for Quality in Health Care

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ObjectiveTo present an update on incidence and mortality from adverse effects (AEs) of medical treatment in the UK, its four countries and nine English regions between 1990 and 2013.DesignDescriptive epidemiological study on AEs of medical treatment. AEs are shown as a single cause-of-injury category from the Global Burden of Disease (GBD) 2013 study.Data sourcesThe GBD 2013 interactive data visualisation tools ‘Epi Visualisation’ and ‘GBD Compare’.Outcome measuresThe means of incidence and mortality rates with 95% uncertainty intervals (UIs). The estimates are age-standardised.ResultsIncidence rate was 175 and 176 cases per 100 000 men, 173 and 174 cases per 100 000 women in 1990 and 2013, in the UK (UI 170–180). The mortality from AEs declined from 1.33 deaths (UI 0.99–1.5) to 0.92 deaths (UI 0.75–1.2) per 100 000 individuals in the UK between 1990 and 2013 (30.8% change). Although mortality trends were descending in every region of the UK, they varied by geography and gender. Mortality rates in Scotland, North East England and West Midlands were highest. Mortality rates in South England and Northern Ireland were lowest. In 2013, age-specific mortality rates were higher in males in all 20 age groups compared with females.ConclusionsDespite gains in reducing mortality from AEs of medical treatment in the UK between 1990 and 2013, the incidence of AEs remained the same. The results of this analysis suggest revising healthcare policies and programmes aimed to reduce incidence of AEs in the UK.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Incidence and mortality from adverse effects of medical treatment in the UK, 1990–2013: levels, trends, patterns and comparisons

Lunevičius

Haagsma

2018

International Journal for Quality in Health Care

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“…The death of Mrs. M, a fit 69-year-old lady, who underwent an elective procedure, is a classic case of clinical futile cycles (CFC) [1][2][3]. This term has been borrowed from biochemistry where two (or more) always on enzymatic systems change one chemical to another and then back to the original chemical with no net output but the use of much energy.…”

Section: Analysis Of Casementioning

confidence: 99%

Adverse Events in Hospitals: “Swiss Cheese” Versus the “Hierarchal Referral Model of Care and Clinical Futile Cycles”

Buist¹

2018

Vignettes in Patient Safety - Volume 3

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The James Reason 'Swiss Cheese' model of adverse event causation has been the predominant principle in the determination and prevention of health-care-associated adverse events for the last 20 years. This model was developed to understand the causation of large-scale organisational and industrial accidents. In principle, it looks for holes in the defence layers of a large organisation that are largely administrative and not the fault of individuals that may be directly involved with the accident. This model has limitations when applied to health care, where most of the errors or accidents are individual technical or competency deficiencies within a background of an ever-changing micro socio-cultural environment. As such, using 'Swiss Cheese' methodology, there has been an over reliance on looking for system issues in health care that has led to a decreased focus on the individual performance of the health-care professional and avoidance of difficult cultural workplace issues. Clinical futile cycles (CFCs) are a model of adverse event causation that primarily focuses on the interaction between the immediate healthcare professionals and patients and between health-care professionals. This focus allows for interventions that address issues such as clinical competency and the culture of the health-care environment.

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“…Buist has labelled such variability as ‘clinical futile cycles’ 24 . Put simply, ward clinicians lacked the skills and knowledge to recognise and manage clinical deterioration reliably.…”

Section: Ward Clinician Skills Before Rrts Were Introducedmentioning

confidence: 99%

“…Buist has labelled such variability as 'clinical futile cycles'. 24 Put simply, ward clinicians lacked the skills and knowledge to recognise and manage clinical deterioration reliably. This 'mismatch between patient needs and resources available' was the impetus for RRTs.…”

Section: Ward Clinician Skills Before Rrts Were Introducedmentioning

confidence: 99%