Failure to rescue.

A thirteen-year-old girl was involved in a car accident which resulted in a ruptured spleen. A CT scan clearly showed the spleen rupture. Her vital signs continued to deteriorate. She suffered a heart attack and was sent to surgery. During surgery she had another heart attack and died. The cause of death was listed as sepsis due to a perforated bowel. The plaintiff sued for failure to timely diagnose the perforated bowel and sepsis. The parties settled for 3 million.

Causes of Failure to Rescue

Not intervening soon enough is a failure to rescue. There are complex factors that contribute to a failure to rescue:

• There may be a failure to monitor.
• The frequency of checking the patient’s blood pressure, heart rate and respiratory rate may not be sufficient to detect deterioration.

Understaffing nursing units contribute to the incidence of failure to rescue. Nurses are the surveillance system needed to recognize and prevention patient deterioration. They are subject to interruptions, distractions, fatigue, chaos, burnout, communication failures and other emergencies.

There may be a failure to recognize the patient’s condition is deteriorating. This may occur because of variations in the healthcare staff’s knowledge and skills. They may be inexperienced.

A barrier to escalating the care is another category of factors that contribute to failure to rescue. Staff may not know how to use the chain of command. Or the staff don’t communicate the urgency of the situation. The staff may fear a negative response or be bullied and intimidated by a person of authority. The staff may lack an effective method of communicating concerns about patients.

The delay in seeing early warning signs may be related to failures in planning, communication and recognition of deterioration.

Prevention of Failure to Rescue

Prevention of incidents of failure to rescue hinges on several interrelated approaches. Patients who are at risk for a failure to rescue are proactively identified. For example, patients at risk for respiratory depression include people who are obese and don’t breathe deeply, have sleep apnea, are receiving pain medication and sedatives, or have a tracheostomy.

It is important that patients with infections be identified early and treated aggressively with antibiotics.

The early diagnosis and treatment of patients who are bleeding is also essential. Changes in blood pressure, pulse and color as well as dropping hemoglobin levels may signify bleeding.

Nursing responsibilities are being restructured to allow them to spend more time at the bedside. Practices that work include giving nurses cell phones, so they don’t have to wait at the nursing station for a return call, streamlining medical record charting, fixing inefficiencies in giving medications, and making rounds to address patient needs. Additional changes include reducing the amount of time nurses have to spend collecting equipment, and using a variety of methods to communicate, such as bedside change of shift reports, and multidisciplinary rounds.

Clinical staff must be trained to make regular observations, be attentive to early recognition of concerning changes, improve communication within the team and effectively react to early warning signs.

Other factors that relate to decreasing failure to rescue events include having a teaching hospital with medical students, interns and residents, having a high percentage of board-certified anesthesiologists, and using more specialized equipment.

Failure to rescue incidents can be reduced by anticipating and preparing for emergencies, paying attention to subtle signs of changes, and recognizing signs of potential complications.

Med League provides medical expert witnesses to trial lawyers. Please call us at (908)788-8227 or contact us today to discuss your next case.