Clinical and Sociocultural Factors Associated With Failure to Escalate Care of Deteriorating Patients

Firas S. Elmufdi, Susan L. Burton, Nishant Sahni, Craig R. Weinert

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

In-hospital medical emergencies occur frequently. Understanding how clinicians respond to deteriorating patients outside the intensive care unit (ICU) could improve “rescue” interventions and rapid response programs. This was a qualitative study with interviews with 40 clinicians caring for patients who had a “Code Blue” activation or an unplanned ICU admission at teaching hospitals over 7 months. Four study physicians independently analyzed interview transcripts; refined themes were linked to the transcript using text analysis software. Nine themes were found to be associated with clinicians’ management of deteriorating patients. Multiple human biases influence daily care for deteriorating hospitalized patients. A novel finding is that “moral distress” affects escalation behavior for patients with poor prognosis. Most themes indicate that ward culture influences clinicians to wait until the last minute to escalate care despite being worried about the patients’ condition.

Original languageEnglish (US)
Pages (from-to)391-396
Number of pages6
JournalAmerican Journal of Medical Quality
Volume33
Issue number4
DOIs
StatePublished - Jul 1 2018

Keywords

  • cardiac arrest
  • deteriorating patients
  • failure to rescue
  • qualitative study
  • unplanned ICU admission

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