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Failure to Rescue and Failure to Perceive Patients in Crisis

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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.

“Failure isn’t fatal, but failure to change might be.”

—John Wooden

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Authors and Affiliations

  1. Department of Internal Medicine, Ysbyty Gwynedd, Penrhosgarnedd, Bangor, Gwynedd, LL57 2PW, UK

    Christian Peter Subbe DM, MRCP

  2. School of Medical Sciences, Bangor University, Bangor, LL57 2AS, UK

    Christian Peter Subbe DM, MRCP

  3. Clinical Professor, Children’s Cardiomyopathy Foundation and Kyle John Rymiszewski Research Scholar, Children’s Hospital of Michigan, Wayne State University School of Medicine, 5057 Woodward Avenue, Suite 13001, Detroit, MI, 48202, USA

    Paul Barach BSc, MD, MPH

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  1. Christian Peter Subbe DM, MRCP
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Correspondence to Christian Peter Subbe DM, MRCP .

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Editors and Affiliations

  1. Department of Surgery Ascension Saint Agnes Hospital Armstrong Institute for Patient Safety & Quality, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Juan A. Sanchez

  2. Children’s Cardiomyopathy Foundation and Kyle John Rymiszewski Research Scholar, Children’s Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA

    Paul Barach

  3. Department of Surgery Center for Healthcare Studies Institute for Public Health and Medicine Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Julie K. Johnson

  4. Division of Cardiovascular Surgery Johns Hopkins All Children’s Heart Institute Johns Hopkins All Children’s Hospital, Johns Hopkins University, Saint Petersburg, FL, USA

    Jeffrey P. Jacobs

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Subbe, C.P., Barach, P. (2017). Failure to Rescue and Failure to Perceive Patients in Crisis. In: Sanchez, J., Barach, P., Johnson, J., Jacobs, J. (eds) Surgical Patient Care. Springer, Cham. https://doi.org/10.1007/978-3-319-44010-1_37

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