Failure Events in Transition of Care for Surgical Patients

Unexpected Failure Events in Surgical Patients: Failure of the System or of the Patient?

“…According to the results of our study, ASA-PS 3 and 4 surgical patients are at higher risk of suffering a failure event. This finding is in accordance with other literature studies and can be adequately explained by the fact that ASA-PS 3 and 4 category involves patients with one or more severe systemic diseases, sometimes poorly controlled with at least some functional limitation [8]. Therefore, it seems necessary to be even more careful when discharging such a patient from the SICU to the ward since monitoring conditions/standards on ward are far less than ideal.…”

Frequency, nature and timing of clinical deterioration in the early postoperative period

“…METs usually consist of an ICU registrar, the treating medical team and critical care nurses. A number of studies have shown that the implementation of RRS such as MET have been beneficial, resulting in earlier recognition and management of clinical deterioration (Casamento, Dunlop, Jones, & Duke, ; Guinane, Bucknall, Currey, & Jones, ; Helling, Martin, Martin, & Mitchell, ; Jones et al., ; Mitchell et al., ; Odell, Victor, & Oliver, ).…”

“…Despite evidence that adherence to ERAS protocols improves patient outcomes (ERAS Compliance Group, 2015, Gustafsson et al, 2011, this patient group remains at high risk of early postoperative clinical deterioration (Seneviratne, Crosbie, Jackson-Jeurgens, & Clough, 2014). Adult patients undergoing major orthopaedic procedures are typically older with underlying cardiovascular, renal and respiratory conditions placing them at high risk of experiencing perioperative cardiac events (Chong et al, 2011), delirium (Staus, 2011) and respiratory tract infections (Roche, Wenn, Sahota, & Moran, 2005 (Casamento, Dunlop, Jones, & Duke, 2008;Guinane, Bucknall, Currey, & Jones, 2013;Helling, Martin, Martin, & Mitchell, 2014;Jones et al, 2012;Mitchell et al, 2010;Odell, Victor, & Oliver, 2009).…”

Role of Transitional Care Measures in the Prevention of Readmission After Critical Illness

“…Readmission to a critical care unit during a hospitalization is also associated with signifi cant increases in illness acuity, overall length of stay, and health care costs. 2,5,7,8,13 Prolonged hospitalization is associated with a diverse and complicated range of impairments that can persist, affect quality of life, and decrease patients' functional capacity for months to years following illness. 4,[13][14][15] Several factors such as presence of intensivists on staff and performance of interdisciplinary discharge rounds have been associated with improved patient triage techniques 2,[8][9][10]16,17 ; premature discharge from and subsequent readmission to a critical care unit has also been correlated with availability of critical care beds and time of day when discharged from the critical care unit to the medical-surgical care area.…”

“…2,5,7,8,13 Prolonged hospitalization is associated with a diverse and complicated range of impairments that can persist, affect quality of life, and decrease patients' functional capacity for months to years following illness. 4,[13][14][15] Several factors such as presence of intensivists on staff and performance of interdisciplinary discharge rounds have been associated with improved patient triage techniques 2,[8][9][10]16,17 ; premature discharge from and subsequent readmission to a critical care unit has also been correlated with availability of critical care beds and time of day when discharged from the critical care unit to the medical-surgical care area. 4,6,9,[17][18][19] Patient indicators associated with increased risk of readmission (see Table) include advanced age at fi rst admission, comorbid conditions at baseline, undergoing emergency versus elective procedures and interventions, higher illness severity scores, cognitive function, oxygen/perfusion ratios on admission and discharge from the critical care unit, and prolonged initial stay in the critical care unit.…”