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Reducing failure to rescue rates in a paediatric in-patient setting: A 9-year quality improvement study
Stephanie McHale1, Takawira C Marufu1, Joseph C Manning1,2
1Nottingham Childrens Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK.
Insights
Targeted interventions significantly reduced failure to rescue (FtR) events in children, decreasing from 23.6% to 2.5% over nine years. This patient safety measure improves pediatric critical care outcomes.
Area of Science:
- Pediatric Critical Care
- Patient Safety
- Quality Improvement Science
Background:
- Over 1.5 million children and young people (CYP) are hospitalized annually in England.
- A significant proportion experience failure to rescue (FtR), characterized by delayed recognition, response, or escalation of clinical deterioration.
- Failure to rescue can lead to severe harm or mortality in pediatric patients.
Purpose of the Study:
- To identify and quantify failure to rescue (FtR) episodes within a tertiary children's hospital.
- To evaluate the impact of targeted interventions on reducing FtR rates.
- To analyze emergency events and their antecedents in pediatric inpatients.
Main Methods:
- A quality improvement approach was utilized, analyzing 170,446 patient admissions from 2011 to 2019.
- Systematic review of all emergency event calls to identify FtR episodes.
- Root-cause analysis and Plan-Do-Study-Act (PDSA) cycles were employed to refine interventions.
Main Results:
- A total of 520 emergency events were reviewed over the 9-year study period.
- Failure to rescue (FtR) rates declined dramatically from 23.6% in 2011 to 2.5% or less in subsequent years.
- Cardiac arrest events constituted 25% of emergency events, predominantly in the Pediatric Critical Care Unit (PCCU).
Conclusions:
- Routinely collected emergency event data can serve as a crucial patient safety metric.
- Targeted interventions, informed by root-cause analysis, are effective in reducing failure to rescue (FtR) rates.
- This quality improvement initiative has implications for reducing unplanned PCCU admissions, mortality, and cardiac arrests in pediatric care.
Background:
Annually in England, over 1.5 million children and young people (CYP) are admitted to hospital. However, a proportion of these CYP will experience failure to rescue (FtR), a failure to recognize, respond and escalate clinical deterioration, which can result in significant harm or death.
Aim:
To identify and quantify FtR episodes from emergency events at a 110-bedded tertiary children's hospital located within a University Teaching Hospital and evaluate the impact of targeted interventions on reducing FtR.
Methods:
A quality improvement approach was adopted. From 170 446 patients admitted between 2011 and 2019, all emergency event calls were systematically reviewed to identify FtR episodes. Root-cause analysis was performed to identify practice deficiencies. The Plan-Do-Study-Act fundamentals were used.
Results:
A total of 520 emergency events were reviewed over the 9-year period. One hundred and thirty-two (n = 132; 25%) were cardiac arrest events, with the majority occurring within the PCCU setting. Three hundred and twelve (60%) of the events were in children who had been inpatient for more than 48 hours. FtR trend declined over the study period from 23.6% in 2011 when the project commenced to 2.5% or less over the following 8 years.
Conclusions:
Identifying rates of FtR events from routinely collected emergency events data can be used as a patient safety measure to identify emergency concerns. This enables dynamic problem solving through delivery of strategic and targeted interventions. The proposed interventions outlined in this quality improvement study have application to critical care nursing as mechanisms for reducing unplanned admissions to paediatric critical care unit (PCCU), patient mortality, and PCCU and non-PCCU cardiac arrests.
Relevance To Clinical Practice:
This study emphasises the importance in understanding the antecedence of emergency events for paediatric inpatient populations. This intelligence can be used to direct targeted interventions to significantly reduce failure to rescue rates.
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