Failure to Rescue Event Mitigation System Assessment: A Mixed-methods Approach to Analysis of Complex Adaptive Systems

McGrath, Susan; Wells, Emily; McGovern, Krystal M; Perreard, Irina; Stewart, Kathleen; McGrath, Dennis; Blike, George T.

doi:10.1108/s1474-823120190000018006

Cited by 5 publications

(3 citation statements)

References 117 publications

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“…Study data also represent baseline performance against which the impact of such interventions can be assessed. More details related to FTR event mitigation and rescue system intervention design and measurement based in part on this work can be found elsewhere [21,34].…”

Section: Discussionmentioning

confidence: 99%

“…The analysis approach and methods stem from systems engineering and improvement domains, which are exploratory in nature, proceeding from general performance analysis to leverage point identification and prioritization of opportunities for improvement. The metrics selected for study were based initially on existing evidence in the literature, previous system-level analysis at the study institution [21], and commonly reported rescue measures, and also influenced by availability of data. Impact of rescue system components, i.e., types of rescue responses, were of particular interest as these are obvious system leverage points.…”

Section: Introductionmentioning

confidence: 99%

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Characterizing rescue performance in a tertiary care medical center: a systems approach to provide management decision support

McGrath

MacKenzie

Perreard

et al. 2021

BMC Health Serv Res

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Background Allocation of limited resources to improve quality, patient safety, and outcomes is a decision-making challenge health care leaders face every day. While much valuable health care management research has concentrated on administrative data analysis, this approach often falls short of providing actionable information essential for effective management of specific system implementations and complex systems. This comprehensive performance analysis of a hospital-wide system illustrates application of various analysis approaches to support understanding specific system behaviors and identify leverage points for improvement. The study focuses on performance of a hospital rescue system supporting early recognition and response to patient deterioration, which is essential to reduce preventable inpatient deaths. Methods Retrospective analysis of tertiary care hospital inpatient and rescue data was conducted using a systems analysis approach to characterize: patient demographics; rescue activation types and locations; temporal patterns of activation; and associations of patient factors, including complications, with post-rescue care disposition and outcomes. Results Increases in bedside consultations (20% per year) were found with increased rescue activations during periods of resource limitations and changes (e.g., shift changes, weekends). Cardiac arrest, respiratory failure, and sepsis complications present the highest risk for rescue and death. Distributions of incidence of rescue and death by day of patient stay may suggest opportunities for earlier recognition. Conclusions Specific findings highlight the potential of using rescue-related risk and targeted resource deployment strategies to improve early detection of deterioration. The approach and methods applied can be used by other institutions to understand performance and allow rational incremental improvements to complex care delivery systems.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Characterizing rescue performance in a tertiary care medical center: a systems approach to provide management decision support

McGrath

MacKenzie

Perreard

et al. 2021

BMC Health Serv Res

Self Cite

View full text Add to dashboard Cite

show abstract

“…A mixed-methods engineering assessment of the complex adaptive sociotechnical system needed to mitigate failure to rescue events provides insight into the full range of factors (human, team, system, organizational) that impact rescue system performance. 47 Early warning scores are often suggested as an alternative method for identifying higher-risk www.anesthesia-analgesia.org…”

Section: Continuous Monitoring Is Effective In Allowing Early Detecti...mentioning

confidence: 99%

Pro-Con Debate: Universal Versus Selective Continuous Monitoring of Postoperative Patients

Blike,

McGrath,

Ochs Kinney

et al. 2024

Anesthesia &Amp; Analgesia

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In this Pro-Con commentary article, we discuss use of continuous physiologic monitoring for clinical deterioration, specifically respiratory depression in the postoperative population. The Pro position advocates for 24/7 continuous surveillance monitoring of all patients starting in the postanesthesia care unit until discharge from the hospital. The strongest arguments for universal monitoring relate to inadequate assessment and algorithms for patient risk. We argue that the need for hospitalization in and of itself is a sufficient predictor of an individual’s risk for unexpected respiratory deterioration. In addition, general care units carry the added risk that even the most severe respiratory events will not be recognized in a timely fashion, largely due to higher patient to nurse staffing ratios and limited intermittent vital signs assessments (e.g., every 4 hours). Continuous monitoring configured properly using a “surveillance model” can adequately detect patients' respiratory deterioration while minimizing alarm fatigue and the costs of the surveillance systems. The Con position advocates for a mixed approach of time-limited continuous pulse oximetry monitoring for all patients receiving opioids, with additional remote pulse oximetry monitoring for patients identified as having a high risk of respiratory depression. Alarm fatigue, clinical resource limitations, and cost are the strongest arguments for selective monitoring, which is a more targeted approach. The proponents of the con position acknowledge that postoperative respiratory monitoring is certainly indicated for all patients, but not all patients need the same level of monitoring. The analysis and discussion of each point of view describes who, when, where, and how continuous monitoring should be implemented. Consideration of various system-level factors are addressed, including clinical resource availability, alarm design, system costs, patient and staff acceptance, risk-assessment algorithms, and respiratory event detection. Literature is reviewed, findings are described, and recommendations for design of monitoring systems and implementation of monitoring are described for the pro and con positions.

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Patterns in continuous pulse oximetry data prior to pulseless electrical activity arrest in the general care setting

McGrath

Perreard

MacKenzie

et al. 2020

J Clin Monit Comput

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Failure to Rescue Event Mitigation System Assessment: A Mixed-methods Approach to Analysis of Complex Adaptive Systems

Cited by 5 publications

References 117 publications

Characterizing rescue performance in a tertiary care medical center: a systems approach to provide management decision support

Characterizing rescue performance in a tertiary care medical center: a systems approach to provide management decision support

Pro-Con Debate: Universal Versus Selective Continuous Monitoring of Postoperative Patients

Patterns in continuous pulse oximetry data prior to pulseless electrical activity arrest in the general care setting

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