Causes, characteristics and improvement strategies for delayed interventions during paediatric deterioration: A mixed
Shannon Cresham Fox1, Takawira C Marufu2, Emma Popejoy2
1Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, Nottinghamshire, United Kingdom; Division of Nursing Science, Pregnancy and Child Health, School of Healthcare, University of Leicester, Leicester, United Kingdom.
Insights
Timely intervention for deteriorating hospitalized children is crucial. Delays in recognition, escalation, and response, influenced by individual, organizational, and systemic factors, increase mortality risk, especially for children with medical complexity.
Area of Science:
- Pediatric critical care
- Patient safety
- Healthcare quality improvement
Background:
- Children's susceptibility to clinical deterioration necessitates prompt recognition and intervention.
- Failure to Rescue (FtR) in pediatric care highlights critical safety gaps due to delayed interventions.
- Understanding factors contributing to delayed interventions is vital for improving outcomes.
Purpose of the Study:
- To identify and evaluate causes and characteristics of delayed interventions in pediatric clinical deterioration.
- To explore improvement strategies for timely intervention in hospitalized children.
- To synthesize evidence on factors influencing delayed recognition, escalation, and response.
Main Methods:
- A mixed-methods systematic review of studies published after 2000.
- Inclusion of hospitalized children aged 0-18 years reporting on Failure to Rescue outcomes.
- Analysis using a convergent segregated approach for qualitative and quantitative data.
Main Results:
- Fifty-two studies synthesized data on over 820,000 children and 4.4 million clinical events.
- Key themes identified: recognition, escalation, and response, with barriers including unclear pathways and training gaps.
- Delays are linked to individual, organizational (e.g., staffing), and systemic factors, disproportionately affecting younger children, those with medical complexity, and global majority populations.
Conclusions:
- Delayed interventions in pediatric care result from a complex interplay of individual, organizational, and systemic factors.
- Children with medical complexity and those from global majority populations face increased risks.
- Nurses are critical in recognizing deterioration and advocating for early intervention, especially in high-risk groups.
Background:
Children are susceptible to deterioration due to compensatory mechanisms. Timely recognition and intervention are strongly associated with improved clinical outcomes, whereas delays elevate mortality risk. Failure to rescue (FtR), the inability to prevent death following deterioration, represents a critical safety concern, yet contributory factors and contextual characteristics remain inadequately synthesised.
Aim:
Identify and evaluate causes, characteristics and improvement strategies associated with delayed intervention during paediatric clinical deterioration in hospitalised children.
Methods:
A mixed-methods systematic review of five databases was conducted including studies on hospitalised children (0-18 years) reporting outcomes related to FtR (e.g. mortality), published after 2000. Rigour was ensured through PROSPERO registration (CRD420250651864) and appraisal checklists. Data were analysed using a convergent segregated approach.
Results:
Fifty-two studies included 820,000 hospitalised children and 4.4 million clinical events were synthesised. Qualitative and quantitative findings resulted in three themes: recognition, escalation and response, with qualitative findings presenting insight into barriers associated with each stage (including unclear escalation pathways and training gaps). Whilst quantitative findings reported prevalence of delayed recognition, escalation and response with pervasive organisational factors contributing to delays (e.g. staffing). Younger children and children with medical complexity (CMC) were at increased risk, and global majority populations were disproportionately affected. Integrated synthesis showed delays stem from individual, organisational, and systemic factors, while experienced nurses play a critical role in timely intervention.
Conclusion:
Individual, organisational and systemic factors contribute to delayed intervention. CMC and global majority populations were disproportionately affected. Findings highlight critical points of delay. Reporting participant characteristics (e.g. ethnicity, medical complexity) is essential to understand their impact upon deterioration pathways.
Implications For Clinical Practice:
Nurses are pivotal in recognising and responding to deterioration, and should recognise high-risk groups. Awareness should translate into advocacy for early intervention.
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