Reducing failure to rescue rates in a paediatric in-patient setting: A 9-year quality improvement study

McHale, Stephanie; Marufu, Takawira C; Manning, Joseph C; Taylor, Nicola

Abstract

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.

Citation

McHale, S., Marufu, T. C., Manning, J. C., & Taylor, N. (2021). Reducing failure to rescue rates in a paediatric in-patient setting: A 9-year quality improvement study. Nursing in Critical Care, https://doi.org/10.1111/nicc.12723

• Journal Article Type: Article
• Acceptance Date: Sep 30, 2021
• Online Publication Date: Oct 19, 2021
• Publication Date: Oct 19, 2021
• Deposit Date: Oct 1, 2021
• Publicly Available Date: Oct 20, 2022
• Journal: Nursing in Critical Care
• Print ISSN: 1362-1017
• Electronic ISSN: 1478-5153
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1111/nicc.12723
• Keywords: patient safety; communication; education; children; cardiac arrest
• Public URL: https://nottingham-repository.worktribe.com/output/6350228
• Publisher URL: https://onlinelibrary.wiley.com/doi/10.1111/nicc.12723
• Additional Information: This is the peer reviewed version of the following article: McHale, S, Marufu, TC, Manning, JC, Taylor, N. Reducing failure to rescue rates in a paediatric in-patient setting: A 9-year quality improvement study. Nurs Crit Care. 2021; 1- 8., which has been published in final form at https://doi.org/10.1111/nicc.12723. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.