Addressing “failure to rescue” with IT solutions

A rare find! Information technology being used enthusiastically by clinicians …. an innovation that both benefits patients and clinicians

There have been a couple of very influential reports that have raised the visibility of the serious issue of patient safety within the healthcare system. The US Institute of Medicine’s report “To Err is Human” in 1999 concluded that tens of thousands of Amercians die each year as a result of preventable mistakes in their care. In the UK, the Department of Health’s report “An organisation with a memory” estimated that adverse incidents occurred in about 1% of hospital admissions and cost over £2bn a year. These adverse events lead to unexpected deaths at worse or, for survivors, a spell in ICU and maybe a resulting long term illness.The great majority of these “adverse incidents” within hospitals (defined as ‘an unintended injury caused by medical management rather than by the disease process’) are preventable or could be mitigated by an early medical response.

The category of adverse events in which the patient’s clinicians fail to respond to the early signs of a patient’s deteriorating condition are called “failure to rescue”. There has been considerable research in the US, Canada, Australia and the UK on the use of early warning scoring (EWS) systems, emergency medical teams and other interventions to try and reduce the mortality and morbidity that results from “failure to rescue” in acute hospitals. Like all causes of clinical risk it is a “whole system” problem that requires a whole system solution – and effective management of clinical information is a key element of the solution.Continue reading