Original CommunicationEscalation of care and failure to rescue: A multicenter, multiprofessional qualitative study
Section snippets
Participants and setting
Attendings/senior residents (seniors) and PGY1s (juniors) from the specialties of General Surgery, Vascular Surgery, and Urology from three hospitals across London were approached for recruitment into this study. Clinicians were given a 1-month window to confirm participation in this study and the final number reflected those with an affirmative response (n = 27, response rate 82%). In addition to these 27 participants, a purposive sample of intensivists, critical care outreach members, and
Results
A total of 41 participants completed this study comprising 16 attending/senior resident grade surgeons (7−25 years' experience), 11 surgical PGY1s, six surgical nurses (3−25 years' experience), 4 intensivists (5−25 years' experience), and four critical care outreach team members (4−10 years' experience). The different number of participants in each group reflected the number of interviews needed to achieve saturation (ie, no new themes were emerging in that group).
Figure displays the key themes
Discussion
This study used qualitative methodology to provide a rich understanding of the problems surrounding surgical EOC that may contribute to a failure to rescue event. It confirmed that patients are exposed to significant harm because of poor escalation attempts and that interventions are required to improve this safety-critical process. All participants underlined the importance of rapid assessment, clinical experience, and intuition in recognizing a sick patient and escalating care promptly. Key
References (23)
- et al.
Hospital characteristics associated with failure to rescue from complications after pancreatectomy
J Am Coll Surg
(2010) - et al.
Variation in mortality after high-risk cancer surgery: failure to rescue
Surg Oncol Clin N Am
(2012) - et al.
Challenging authority during a life-threatening crisis: the effect of operating theatre hierarchy
Br J Anaesth
(2013) - et al.
Clinicians' responses to abnormal vital signs in an emergency department
Aust Crit Care
(2006) - et al.
Why is the surgical high-risk patient still at risk?
Br J Anaesth
(2011) - et al.
Overcoming gendered and professional hierarchies in order to facilitate escalation of care in emergency situations: the role of standardised communication protocols
Soc Sci Med
(2010) - et al.
Trends in hospital volume and operative mortality for high-risk surgery
N Engl J Med
(2011) - et al.
Complications in surgical patients
Arch Surg
(2002) - et al.
An observational study of the frequency, severity, and etiology of failures in postoperative care after major elective general surgery
Ann Surg
(2013) - et al.
Hospital and patient characteristics associated with death after surgery. A study of adverse occurrence and failure to rescue
Med Care
(1992)
Complications, failure to rescue, and mortality with major inpatient surgery in medicare patients
Ann Surg
Cited by (0)
This study was supported by funding from the London Deanery; the funders had no role in the study.
Drs Johnston, Arora, King, and Darzi are affiliated with the Centre for Patient Safety and Service Quality (www.cpssq.org) at Imperial College, which is funded by the National Institute for Health Research, UK.