Reducing failure to rescue rates in a paediatric in‐patient setting: A 9‐year quality improvement study

Aim: To identify and quantify Failure to Rescue (FtR) episodes from emergency events at a large children’s hospital and understand the impact of targeted interventions on reducing FtR. Methods: A quality improvement approach was adopted. From 2011 – 2019 all emergency event calls were systematically reviewed prospectively to identify FtR episodes. Root-cause analysis was performed to identify practice deficiencies. The Plan-Do-Study-Act fundamentals were used. Results: A total of 520 (100%) emergency events were reviewed, with yearly mean of 58 events (SD 13, range 41- 81). Cardiac arrest events were the most common 132 (25.8%). Out of the total 132 (100%) cardiac arrest events, 116 (88%) occurred in paediatric critical care unit and only 16 (12%) occurred in general paediatric wards. Three hundred and twelve (60%) of the events were observed in children who had been inpatient for > 48 hours. Observed FtR figures over the nine years was characterised by high rate of 23.6% in 2011 when the project commenced followed subsequently by a sharp decrease after interventions and remained at 2.5% or below for the last six years.Conclusion: Identifying rates of FtR events from routinely collected emergency events data can be used as a patient safety measure to identify emergency concerns. This enables progressive dynamic problem solving through delivery of strategic targeted interventions. The proposed interventions outlined in this quality improvement study have application to critical care nursing as mechanisms for reducing in-hospital unplanned admissions to paediatric critical care