Finding patients before they crash: the next major opportunity to improve patient safety

Bates, David W.; Zimlichman, Eyal

doi:10.1136/bmjqs-2014-003499

Cited by 85 publications

(41 citation statements)

References 18 publications

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“…The critical safety issue however is how to detect deterioration. In the context of hospitals David Bates and Eyal Zimmerman have argued that 'fi nding patients before they crash' is the next major opportunity to improve patient safety (Bates and Zimlichman 2014 ). In hospitals the primary tools to improve detection are the electronic health record, physiological sensors, decision analytics and mobile phones, with the assumption of a rapid clinical response once deterioration is identifi ed.…”

Section: Detecting Deteriorationmentioning

confidence: 99%

Safety Strategies for Care in the Home

Vincent

Amalberti

2016

Safer Healthcare

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Patient safety has evolved and developed in the context of hospital care. The understanding we have of the epidemiology of error and harm, the causes and contributory factors and the potential solutions are almost entirely hospital based. Safety in home care is likely to require different concepts, approaches and solutions. Safety in this context has however been barely addressed and yet care provided in the home will soon become the most important context for healthcare delivery.The term 'home care' can encompass a variety of residential settings in which people are cared for by family, nurses and other professionals. In this chapter we use the term in a more restricted way to refer to the care of people in their own home, with varying degrees of informal and professional support. We focus on people with illnesses, usually chronic conditions, who are either living independently or being supported in their own homes by family or professional carers. Much healthcare is already delivered in the patient's home and this form of provision is growing rapidly. The benefi ts of home based care have been widely discussed, but the risks have not been fully articulated. In this chapter we fi rst briefl y summarise the background to the expansion of home care and then consider the nature and challenges for patient safety and the strategies that might help us manage risk in the home. An Ageing Population and the Expansion of Home CareMore than 20 % of citizens in developed countries will be over 65 in 2020. These people, while enjoying better quality of life than previous generations, will suffer from a variety of long term conditions. As we discussed earlier, patients with cancer, heart disease, dementia, renal and respiratory disorders may now live for decades with their disease. The most common causes of disability however are due to sight and hearing disorders which affect very large numbers of people and are particularly pertinent to safety in the home. As well as an absolute increase in the numbers of older people, there will also be a considerable relative increase. The socalled 'support ratio' -the ratio of people of working age to those over 65 -will

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Section: Detecting Deteriorationmentioning

confidence: 99%

Safety Strategies for Care in the Home

Vincent

Amalberti

2016

Safer Healthcare

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“…This resulted in a mortality reduction in two geographically separated hospitals. A host of sensors are becoming available, and when linked to communication tools and used with analytics, these approaches have substantial potential for improving outcomes, including in patients with suspected infection [33]. An important general frontier in informatics, as the use of electronic health records rises, is how to get clinicians to use prediction rules like these, and how to manage issues such as missing data in the rules in real time.…”

Section: Eliakim-raz Et Al Predicting Bacteraemia In Validated Modelsmentioning

confidence: 99%

Predicting bacteraemia in validated models—a systematic review

Eliakim‐Raz

Bates

Leibovici

2015

Clinical Microbiology and Infection

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Bacteraemia is associated with high mortality. Although many models for predicting bacteraemia have been developed, not all have been validated, and even when they were, the validation processes varied. We identified validated models that have been developed; asked whether they were successful in defining groups with a very low or high prevalence of bacteraemia; and whether they were used in clinical practice. Electronic databases were searched to identify studies that underwent validation on prediction of bacteraemia in adults. We included only studies that were able to define groups with low or high probabilities for bacteraemia (arbitrarily defined as below 3% or above 30%). Fifteen publications fulfilled inclusion criteria, including 59 276 patients. Eleven were prospective and four retrospective. Study populations and the parameters included in the different models were heterogeneous. Ten studies underwent internal validation; the model performed well in all of them. Twelve performed external validation. Of the latter, seven models were validated in a different hospital, using a new independent database. In five of these, the model performed well. After contacting authors, we found that none of the models was implemented in clinical practice. We conclude that heterogeneous studies have been conducted in different defined groups of patients with limited external validation. Significant savings to the system and the individual patient can be gained by refraining from performing blood cultures in groups of patients in which the probability of true bacteraemia is very low, while the probability of contamination is constant. Clinical trials of existing or new models should be done to examine whether models are helpful and safe in clinical use, preferably multicentre in order to secure utility and safety in diverse clinical settings.

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“…A discord between actual measurements obtained, often as digital values from automated observation devices (Bellomo et al . ), and recording vital signs in ranges was, however, apparent with our study participants in actual practice; one that may not be fully resolved until complete adoption of a digitised and networked practice environment is realised (Bates & Zimlichman ).…”

Section: Discussionmentioning

confidence: 91%

User acceptance of observation and response charts with a track and trigger system: a multisite staff survey

Elliott

Allen

McKinley

et al. 2016

Journal of Clinical Nursing

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Aims and objectives. To examine user acceptance with a new format of charts for recording observations and as a prompt for responding to episodes of clinical deterioration in adult medical-surgical patients. Background. Improving recognition and response to clinical deterioration remains a challenge for acute healthcare institutions globally. Five chart templates were developed in Australia, combining human factors design principles with a track and trigger system for escalation of care. Two chart templates were previously tested in simulations, but none had been evaluated in clinical practice. Design. Prospective multisite survey of user acceptance of the charts in practice. Methods. New observation and response charts were trialled in parallel with existing charts for 24 hours across 36 adult acute medical-surgical wards, covering 108 shifts, in five Australian states. Surveys were completed by 477 staff respondents, with open-ended comments and narrative from short informal feedback groups providing elaboration and context of user experiences. Results. Respondents were broadly supportive of the chart format and content for monitoring patients, and as a prompt for escalating care. Some concerns were noted for chart size and style, use of ranges to graph vital signs and with specific human factors design features. Information and training issues were identified to improve usability and adherence to chart guidelines and to support improved detection and response for patients with clinical deterioration.Conclusions. This initial evaluation demonstrated that the charts were perceived as appropriate for documenting observations and as a prompt to detect clinical deterioration. Further evaluation after some minor modifications to the chart is recommended.What does this paper contribute to the wider global clinical community?• Implementing practice initiatives to improve recognition and response to clinical deterioration (the afferent limb of the rapid response system) remains a global healthcare challenge This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. Relevance to clinical practice. Explicit training on the principles and rationale of human factors chart design, use of embedded change management strategies and addressing practical issues will improve authentic engagement, staff acceptance and adoption by all clinical users when implementing a similar observation and response chart into practice.

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Finding patients before they crash: the next major opportunity to improve patient safety

Cited by 85 publications

References 18 publications

Safety Strategies for Care in the Home

Safety Strategies for Care in the Home

Predicting bacteraemia in validated models—a systematic review

User acceptance of observation and response charts with a track and trigger system: a multisite staff survey

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