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

Title: Escalation of care and failure to rescue: a multicenter, multiprofessional qualitative study
Authors: Johnston, M
Arora, S
King, D
Stroman, L
Darzi, A
Item Type: Journal Article
Abstract: Background The escalation of care process has not been explored in surgery, despite the role of communication failures in adverse events. This study aimed to develop a conceptual framework of the influences on escalation of care in surgery allowing solutions to facilitate management of sick patients to be developed. Methods A multicenter qualitative study was conducted in three hospitals in London, UK. A total of 41 participants were recruited, including 16 surgeons, 11 surgical PGY1s, six surgical nurses, four intensivists, and four critical care outreach team members. Participants were submitted to semistructured interviews that were analyzed using grounded theory methodology. Results A decision to escalate was based upon five key themes: patient, individual, team, environmental, and organizational factors. Most participants felt that supervision and escalation of care were problematic in their hospital, with unclear escalation protocols and poor availability of senior surgical staff the most common concerns. Mobile phones and direct conversation were identified to be more effective when escalating care than hospital pager systems. Transparent escalation protocols, increased senior clinician supervision, and communication skills training were highlighted as strategies to improve escalation of care. Conclusion 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.
Issue Date: 1-Jun-2014
Date of Acceptance: 31-Jan-2014
URI: http://hdl.handle.net/10044/1/60441
DOI: https://dx.doi.org/10.1016/j.surg.2014.01.016
ISSN: 0039-6060
Publisher: Elsevier
Start Page: 989
End Page: 994
Volume: 155
Issue: 6
Copyright Statement: © 2014 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
Funder's Grant Number: NF-SI-0510-10186
Keywords: Science & Technology
Life Sciences & Biomedicine
Attitude of Health Personnel
Decision Making
Interprofessional Relations
Interviews as Topic
Patient Care Team
Patient Safety
Postoperative Care
Postoperative Complications
Treatment Failure
1103 Clinical Sciences
Publication Status: Published
Online Publication Date: 2014-02-07
Appears in Collections:Department of Surgery and Cancer
Institute of Global Health Innovation