The Consensus Statement focuses on ensuring that a clinical safety net is in place for patients whose condition is acutely deteriorating and outlines the organisational supports that are needed to provide this safety net. It applies to all patients in all settings where acute health care is provided.
How is your organisation addressing essential element 7 – Education and Training as part of the Essential elements for recognising and responding to acute physiological deterioration (third edition)?
What does the evidence say?
An excellent article called “Failure to Rescue Deteriorating Patients: A Systematic Review of Root Causes and Improvement Strategies” published in the Journal of patient safety in January 2022, used a systematic review and the following electronic databases were searched between January 1, 2006, to February 12, 2018: MEDLINE, PsycINFO, Cochrane Library, CINAHL, and BNI databases. All studies that explored an intervention to improve failure to rescue in the adult population were considered.
Their conclusions demonstrated that “complications occur consistently within healthcare organizations. They represent a huge burden on patients, clinicians, and healthcare systems. Organizations vary in their ability to manage such events. Failure to rescue, is a measure of institutional competence in this context. They propose “The 3 Rs of Failure to Rescue” of recognize, relay, and react and hope that this serves as a valuable framework for understanding the phases where failure of patient salvage may occur. Future efforts at mitigating the differences in outcome from complication management between units may benefit from incorporating this proposed framework into institutional quality improvement”.
As you might expect, interdisciplinary team training and simulation-based learning featured as strong pillars of organisational risk mitigation strategies, leading to lower in hospital patient mortality.
“Crew resource management is used in the aviation industry was proposed by the Institute of Medicine following their report, To Err is Human: Building a Safer Healthcare System (1) as a means of mitigating the problems that arise from poor communication and teamwork. This involves clinical leadership taking active roles in developing team training, integration into standard teaching, use of simulation, and investment at the medical and nursing school level” (2).
“Crew resource management involves situations where the whole team can train in simulated crisis scenarios in a safe environment (3). Where comprehensive multidisciplinary safety programs have been instituted across units, improved patient outcome has been reported in addition to improvements in healthcare staff perceptions to team working” (4).
“In a large study of 182,409 patients from Veteran Affairs hospitals, after structured medical team training programs, an 18% reduction in annual mortality was observed in trained facilities compared with a 7% decrease in nontrained hospitals in surgical patients” (5-6).
How healthcare institutions choose to plan, invest and resource their clinical workforces to address “how to appropriately respond to clinical patient deterioration” is crucial, but three elements stand out for me from the essential element 7 guideline, under education and training:
7.3 Rapid response clinicians require additional training to respond to deteriorating patients.
7.4 In accordance with the local rapid response system, a sufficient number of clinicians should be competent in advanced life support to provide emergency assistance and an accessible register of currency should be maintained within the health service organisation.
7.5 A range of methods should be used to provide knowledge and skills to clinicians. These may include information at orientation, face-to-face and online techniques, as well as simulation and scenario-based training. Training should be multidisciplinary and include common life-threatening presentations to the rapid response team.
A positive way forward should see the development of targeted curriculum or programs which embrace the Rapid cycle, Deliberate practice, or Low Dose High Frequency approach to technical skills development and team based training.
References
1. Institute of Medicine. To Err Is Human: Building a safer Health System.Kohn, LT, Corrigan JA, Donaldson MS (eds). Institute of Medicine (US)Committee on Quality of Health Care in America. Washington, DC: National Academies Press (US); 2000.
2. Musson DM, Helmreich RL. Team training and resource management in health care: current issues and furture directions. Musson Helmreich eam Train Resour Manag. 2004;5:109–111.
3. Scalese RJ, Obeso VT, Issenberg SB. Simulation technology for skills training and competency assessment in medical education. J Gen Intern Med. 2008;23(S1):46–49.
4. Pronovost PJ, Weast B, Rosenstein B, et al. Implementing and validating a comprehensive unit-based safety programme. J Patient Saf. 2005;1:33–40.
5. Neily J, Mills PD, Young-Xu Y, et al. Association between implementation of a medical team training program and surgical mortality. JAMA. 2010; 304:1693–1700.
6. Burke, Joshua R. MBcHB, BSc (Hons), MRCS, PGCert∗; Downey, Candice MBChB, BSc (Hons), PGDip, MRCS∗; Almoudaris, Alex M. BSc (Hons), MBBS, DIC, PhD, FRCS†,‡ Failure to Rescue Deteriorating Patients: A Systematic Review of Root Causes and Improvement Strategies, Journal of Patient Safety: January 2022 – Volume 18 – Issue 1 – p e140-e155 doi: 10.1097/PTS.0000000000000720
7. https://www.safetyandquality.gov.au/publications-and-resources/resource-library/national-consensus-statement-essential-elements-recognising-and-responding-acute-physiological-deterioration-third-edition
