Failure to Rescue is ranked #2 in healthcare claims in Canada (HIROC, 2017) Additionally, Health Standards Organization (HSO) recently updated the critical care and inpatient services standards sets to include requirements supporting the recognition and response to clinical deterioration. Full details: https://goo.gl/cfTUrm

1. Clinical Deterioration;
What can I do?

3. Goals for today’s call:
Participants will understand:
 how the patient/family member can support
recognition of clinical deterioration;
 why this is a healthcare concern;
 how early warning systems can assist in recognition of
clinical deterioration;
 where to access tools and resources to support
improvement efforts regarding recognition of and
response to, clinical deterioration.

4. Donna Davis
PFPSC
Joanna Noble
HIROC
Michael Miletin, William Osler
Health System, Toronto
Sabina Robin
PFPSC

5. Vance’s
Story….
The patient /family
perspective
Donna Davis; Patient Safety Champion

6. Why is this an issue?
Joanna Noble,
Supervisor Knowledge
Transfer Healthcare Risk
Management, HIROC

7. HIROC’s claims database & “KT” strategy
https://www.hiroc.com/Risk‐Management/Risk‐Reference‐Sheets.aspx

8. FACT: failure to appreciate patient status
changes/deterioration is HIROC’s top
ranked risk
Sector Ranking
by claims
costs
Obstetrics #1
Acute care #2
Home care #2
Community health #3
Mental health #10
Nursing/personal care homes, LTC #12
Chronic/complex continuing/rehab #12

9. Patient deterioration claims - common
contributing factors
Inconsistent documentation of
vitals, assessments & consultations
“Normalizing” the abnormal
Patient/family concerns not acknowledged/
acted on
Informal ‘hallway’ discussions/
consults
Delayed & ineffective team communications
Staff hesitating to escalate care
concerns
Loss of “situational awareness”

12. Revisions to HSO Standards - 2017
Critical Care standards set:
6.2 The critical care team works with other teams in the
organization to determine the process for monitoring
clients that includes escalating care to the critical
care unit.
Inpatient Services standards set:
7.6 Clients and families are provided with information on how to identify
when an escalation in care may be needed and how to initiate the process.
10.10 When signs of increased acuity are present, the team assesses the
client’s risk and follows processes to escalate care.

13. The provider’s
perspective
Michael Miletin,
William Osler Health
System, Toronto

17. RR,

18. << Prev Figure 1 Next >>PMC full text: Crit Care. 2009; 13(5): 313.
Published online 2009 Oct 6. doi: 10.1186/cc7996
Copyright/License ► Request permission to reuse
Figure 1
Scatter plot and line of regression showing association between increased Medical Emergency Team
(MET) call rate ('MET dose') and percentage reduction in cardiac arrest rate from baseline. Adapted
from Jones and colleagues [16].

21. 2008

35. Stable
patient
AEGIS ALERT
triggered
RRT calling
criteria met
Code Blue
< 24 hours
ICU Admission
Abnormal
vital signs

36. Stable
patient EWS ALERT
triggered
CCRT calling
criteria met
Code Blue
ICU Admission
Early Assessment and
Response by ward team

42. 0
1
2
3
4
5
6
7
8
9
2013 2014 2015 2016
BCH
EGH
POST AEGISPRE AEGIS

43. 0
100
200
300
400
500
600
700
800
2013 2014 2015 2016

44. 75
80
85
90
95
100
105
110
2012/13 2013/14 2014/15 2015/16 2016/17
Hospital Standardized Mortality Ratio
Osler BCH EGH

46. Tools and
Resources
Sabina Robin
Patient Safety
Champion;
Patients for Patient
Safety Canada

47. www.patientsafetyinstitute.ca/DeterioratingPatientCondition