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Failure to Rescue and Failure to Perceive Patients in Crisis

Chapter

Abstract

“Failure to rescue” of hospitalized patients with deteriorating physiology on general wards is caused by a complex array of organizational, technical, and cultural failures including a lack of standardized team and individual response patterns and actions. Hospitals have introduced Rapid Response Systems, which is an increasingly standardized evaluation and escalation treatment paradigm for patients with physiological derangements. In contrast, the efferent limb clinical response is much more variable and ranges from the patient’s primary care team, to lone nurse practitioners, to dedicated Rapid Response Teams with intensive care, medical, nursing, and allied care providers. Failure to rescue resolution requires understanding of the physiology of deteriorating patients as well as the sociology of hospitals and the psychology of individuals. Serious social science, confirmed by statistical analysis and experiment indicates that vital signs will pinpoint the majority of patients at risk and needs to be supplemented by regular and recurring assessments of physiological reserve. RRS are a means to drive safer care across organizations. In order to thrive they require a change in the underlying safety culture with an acceptance that the individual clinician is always fallible and requires redundancy for safety critical steps.

Keywords

Early deterioration identification tools and scores Rapid Response Team Evaluation challenges Patient safety Clinical microsystems Quality of care 

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Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Department of Internal MedicineYsbyty GwyneddBangor, GwyneddUK
  2. 2.School of Medical Sciences, Bangor UniversityBangorUK
  3. 3.Clinical Professor, Children’s Cardiomyopathy Foundation and Kyle John Rymiszewski Research ScholarChildren’s Hospital of Michigan, Wayne State University School of MedicineDetroitUSA

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