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 journalArticle

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

Fingerprint

Patient Care
Intensive Care Units
Interviews
Cardiopulmonary Resuscitation
Teaching Hospitals
Emergencies
Software
Physicians

Keywords

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

PubMed: MeSH publication types

  • Journal Article

Cite this

Clinical and Sociocultural Factors Associated With Failure to Escalate Care of Deteriorating Patients. / Elmufdi, Firas S; Burton, Susan L; Sahni, Nishant; Weinert, Craig R.

In: American Journal of Medical Quality, Vol. 33, No. 4, 01.07.2018, p. 391-396.

Research output: Contribution to journalArticle

@article{ffb496e0a9f040b09e6f55d5f2f93f19,
title = "Clinical and Sociocultural Factors Associated With Failure to Escalate Care of Deteriorating Patients",
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.",
keywords = "cardiac arrest, deteriorating patients, failure to rescue, qualitative study, unplanned ICU admission",
author = "Elmufdi, {Firas S} and Burton, {Susan L} and Nishant Sahni and Weinert, {Craig R}",
year = "2018",
month = "7",
day = "1",
doi = "10.1177/1062860617748739",
language = "English (US)",
volume = "33",
pages = "391--396",
journal = "American journal of medical quality : the official journal of the American College of Medical Quality",
issn = "1062-8606",
publisher = "SAGE Publications Inc.",
number = "4",

}

TY - JOUR

T1 - Clinical and Sociocultural Factors Associated With Failure to Escalate Care of Deteriorating Patients

AU - Elmufdi, Firas S

AU - Burton, Susan L

AU - Sahni, Nishant

AU - Weinert, Craig R

PY - 2018/7/1

Y1 - 2018/7/1

N2 - 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.

AB - 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.

KW - cardiac arrest

KW - deteriorating patients

KW - failure to rescue

KW - qualitative study

KW - unplanned ICU admission

UR - http://www.scopus.com/inward/record.url?scp=85041594435&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85041594435&partnerID=8YFLogxK

U2 - 10.1177/1062860617748739

DO - 10.1177/1062860617748739

M3 - Article

VL - 33

SP - 391

EP - 396

JO - American journal of medical quality : the official journal of the American College of Medical Quality

JF - American journal of medical quality : the official journal of the American College of Medical Quality

SN - 1062-8606

IS - 4

ER -