Escalation of care and failure to rescue: A multicenter, multiprofessional qualitative study

Abstract

This is the first study to describe escalation of care in surgery, a key process for protecting the safety of deteriorating surgical patients. Factors affecting the decision to escalate are complex, involving clinical and professional aspects of care. An understanding of this process could pave the way for interventions to facilitate escalation in order to improve patient outcome.

Early warning systems and rapid response to the deteriorating patient in hospital: A systematic realist review

“…The underutilisation or delays in activation were found to be due to failure to recognise deterioration (Azzopardi et al 2011), lack of understanding regarding role of RRT (Massey et al 2014), escalation protocol not clear to junior nurses (Johnston et al 2014, Braaten 2015, fear of criticism (Azzopardi et al 2011;Johnston et al 2014;Massey et al 2014), staff attempting to deal with the situation by conventional ward care (Shearer et al 2012, Braaten 2015, waiting for further investigations (Shearer et al 2012), preference to rely on own clinical judgement when deciding to call RRT (Shearer et al 2012;Radeschi et al 2015), consulting peers (Donohue & Endacott 2010;Massey et al 2014;Braaten 2015) or seeking ward medical review before calling the RRT (Azzopardi et al 2011, Oglesby et al 2011, Braaten 2015, Radeschi et al 2015.…”

The relationship between trauma center volume and in-hospital outcomes

“…As an indicator for quality of care, FTR is thought to be less sensitive to patient characteristics than in-hospital mortality rates and may better reflect center performance [21,22]. FTR possibly helps explain observed differences in risk-adjusted mortality rates by accounting for the extent to which care coordination between providers and hospital organization is responsible for center outcomes [23,24].…”

Effectiveness of interventions to improve patient handover in surgery: A systematic review

“…Furthermore, in the event of clinical deterioration, patients may be subject to particularly critical handovers during the escalation of care. 2 Clinical handoff or handover may be defined as the transfer of professional responsibility and accountability for a patient's care to another professional. 3 Appropriate and effective communication is a crucial component of handover to ensure effective continuity of care 4,5 and to prevent failures associated with errors, adverse events, 6 and avoidable patient harm.…”