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A systematic review to identify the factors that affect failure to rescue and escalation of care in surgery

Title: A systematic review to identify the factors that affect failure to rescue and escalation of care in surgery
Authors: Johnston, MJ
Arora, S
King, D
Bouras, G
Almoudaris, AM
Davis, R
Darzi, A
Item Type: Journal Article
Abstract: Background The relationship between the ability to recognize and respond to patient deterioration (escalate care) and its role in preventing failure to rescue (FTR; mortality after a surgical complication) has not been explored. The aim of this systematic review was to determine the incidence of, and factors contributing to, FTR and delayed escalation of care for surgical patients. Methods A search of MEDLINE, EMBASE PsycINFO, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials was conducted to identify articles exploring FTR, escalation of care, and interventions that influence outcomes. Screening of 19,887 citations led to inclusion of 42 articles. Results The reported incidence of FTR varied between 8.0 and 16.9%. FTR was inversely related to hospital volume and nurse staffing levels. Delayed escalation occurred in 20.7–47.1% of patients and was associated with greater mortality rates in 4 studies (P < .05). Causes of delayed escalation included hierarchy and failures in communication. Of five interventional studies, two reported a significant decrease in intensive care admissions (P < .01) after introduction of escalation protocols; only 1 study reported an improvement in mortality. Conclusion This systematic review explored factors linking FTR and escalation of care in surgery. Important factors that contribute to the avoidance of preventable harm include the recognition and communication of serious deterioration to implement definitive treatment. Targeted interventions aiming to improve these factors may contribute to enhanced patient outcome.
Issue Date: 1-Apr-2015
Date of Acceptance: 31-Oct-2014
URI: http://hdl.handle.net/10044/1/60415
DOI: https://dx.doi.org/10.1016/j.surg.2014.10.017
ISSN: 0039-6060
Publisher: Elsevier
Start Page: 752
End Page: 763
Volume: 157
Issue: 4
Copyright Statement: © 2015 Elsevier Ltd. All rights reserved. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/
Sponsor/Funder: National Institute for Health Research
Imperial College Healthcare NHS Trust
National Institute for Health Research (NIHR)
Funder's Grant Number: NF-SI-0510-10186
RDPSC 79560
RDPSC 79560
Keywords: Science & Technology
Life Sciences & Biomedicine
Surgery
MEDICAL EMERGENCY TEAM
IN-HOSPITAL MORTALITY
RAPID RESPONSE TEAM
INPATIENT SURGERY
CALLING CRITERIA
GROUNDED THEORY
ADVERSE EVENTS
OLDER-PEOPLE
RISK-FACTORS
OUTCOMES
Clinical Protocols
Critical Care
Delayed Diagnosis
Humans
Interprofessional Relations
Postoperative Care
Postoperative Complications
Quality Indicators, Health Care
Treatment Failure
1103 Clinical Sciences
Publication Status: Published
Online Publication Date: 2015-03-18
Appears in Collections:Division of Surgery
Faculty of Medicine



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