As discussed in the last few posts, failure to rescue is a serious cause of morbidity and mortality to patients who might otherwise have done reasonably well in their hospital stay. There are steps that healthcare centers can take to reduce the risk of failing to rescue a patient. The below list is not a comprehensive list, but it is a start.
- Enhanced Training and Education: Provide ongoing training for healthcare providers on recognizing early signs of deterioration and responding appropriately. This includes simulation training and mock scenarios to practice rapid response. Generally, training is considered to be a weak intervention to improve safety. However, formal training programs such as clinical team training (used in the VA) or TeamSTEPPS (developed by AHRQ) can help create better and more highly functioning clinical teams if there is real commitment on the part of the organization.
- Use of Rapid Response Teams (RRT): Establish rapid response teams composed of skilled clinicians who can be called upon to assess and manage deteriorating patients in non-critical care areas of the hospital. These teams can provide specialized care before the situation escalates. The best systems allow anyone to call the team, this can include family members. Even better, is the use of automated systems that monitor vital signs and if they reach concerning levels an automated call goes out to the rapid response team. This helps take the pressure off of the nursing team to always be the people calling the RRT.
- Standardized Protocols: Develop and implement standardized protocols for managing specific complications. These protocols guide healthcare providers in taking consistent and evidence-based actions to rescue patients in distress. Such protocols can help avoid concerns by team members that they are asking for something special. Instead, they are just adhering to the expectations set in established and standardized protocols.
- Improved Communication: Implement clear and efficient communication processes to ensure that critical information is shared accurately and promptly among healthcare providers. Programs such as Clinical Team Training establish ways to improve communication in ways that are clear, concise and direct. The VA uses communication tools such as the 3 W’s (What I see, What I am Concerned About, What I want) and other tools to improve clinical team performance.
- Continuous Monitoring: Implement continuous monitoring of patients’ vital signs, especially in high-risk areas or for patients with complex medical conditions or anytime there is a change in clinical status, even when the change initially seems small.
- Utilization of Technology: Use technological solutions, such as electronic health records and early warning systems, to track patient data and trigger alerts when a patient’s condition deviates from normal parameters. Some of these technologies can be used to better inform rapid response teams and to create predictive models that may be early warning signals for patients at risk for decline.
Addressing failure to rescue requires a system-wide commitment to patient safety and quality improvement. By focusing on early recognition, effective communication, standardized protocols, and ongoing education, healthcare systems can mitigate the risk of adverse events and provide higher quality care to their patients.
The last thing I will stress, is that when a healthcare system fails their patients, it is their responsibility to do an honest disclosure to the patient and/or families that are impacted. Some states have regulations that enforce this and Medicare also appears to have a policy that requires the disclose of adverse events arising from a hospital stay. It may be hard for facilities, and they may fear litigation, but they need to own their responsibility in the harms they have caused. It is ethically the correct thing to do, and increasingly it appears to be an expectation in policy and in some states laws. If hospitals do not do this, patients and families should contact Medicare, state public health departments (that may have regulatory oversight), or the entities that regulate hospitals (The Joint Commission or DNV).