Causes, characteristics and improvement strategies for delayed interventions during paediatric deterioration: A mixed...

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.

Identify and evaluate causes, characteristics and improvement strategies associated with delayed intervention during paediatric clinical deterioration in hospitalised children.

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.

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.

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.

Nurses are pivotal in recognising and responding to deterioration, and should recognise high-risk groups. Awareness should translate into advocacy for early intervention.