Review : Continuous Monitoring to Detect Failure to Rescue in Adult Postoperative Inpatients

Abstract

Failure to rescue, or the unexpected death of a patient due to a preventable complication, is a nationally documented problem with numerous and multifaceted contributing factors. These factors include the frequency and method of collecting vital sign data, response to abnormal vital signs, and delays in the escalation of care for general ward patients who are showing signs of clinical deterioration. Patients' clinical deterioration can be complicated by concurrent secondary factors, including opioid abuse/dependence, being uninsured, or having sleep-disordered breathing. Using the Johns Hopkins Nursing Evidence-Based Practice Model, this integrative review synthesizes 43 research and nonresearch sources of evidence. Published between 2001 and 2017, these sources of evidence focus on failure to rescue, the multifaceted contributing factors to failure to rescue, and how continuous vital sign monitoring could ameliorate failure to rescue and its causes. Recommendations from the sources of evidence have been divided into system, structural, or technological categories.

Adverse events in a new intensive care unit. Influence of healthcare facilities design and technology on incidence rates

“…Continuous vital signs monitoring with adequate surveillance equipment is known to reduce the possibility of unexpected death secondary to preventable complications in hospitalized patients. 20,21 There are some limitations of this study that deserve to be commented, such as the difficulty to know how many days the patients were at risk of suffering each adverse event. In addition, the analysis corresponds to a single ICU with admission of patients predominantly presenting with respiratory pathology, and the results may therefore not be susceptible to be generalized to other settings.…”

Eventos adversos en una nueva unidad de cuidados intensivos. Influencia del diseño y la tecnología de las instalaciones en las tasas de incidencia

“…Se sabe que el monitoreo continuo de signos vitales con equipamiento de vigilancia adecuado aminora la posibilidad de muerte inesperada secundaria a complicaciones prevenibles en pacientes hospitalizados. 20,21 Existen algunas limitaciones de este estudio que merecen comentarse, como la dificultad para saber cuántos días los pacientes estuvieron en riesgo de padecer cada evento adverso. Además, el análisis corresponde a una sola UCI con ingreso de pacientes predominantemente portadores de patología respiratoria, por lo que los resultados pueden no ser susceptibles de generalizarse a otros entornos.…”

Failure To Rescue, What Can Be Done To Prevent It?

“…There are some barriers for the implementation of such technologies, as inadequate training or unfamiliarity with them, challenges in incorporating them into the clinical workflow, or budget restrictions, but there are also facilitators such as education to these systems, valuing how these technologies worked in the hospital they are being implemented in, tailoring them and integrating them into existing workflows and receiving regular feedback about progress [22]. There is still needed research in this area about which parameters should be captured, or if all patients should be monitored or specific types of patients [23].…”

“…Another strategy to improve the detection of patients that can be deteriorating is the use of continuous monitoring in general wards, that can provide dynamic information about the patterns of the vital signs of the patient, and there can also be achieved an automation of the calculation of scores to trigger an escalation of care [20][21][22][23][24]. These automated programs also can be used in the ICU context, where is already continuous monitoring to help prevent FTR events in this setting [25].…”