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Evaluation of a patient and family activated escalation system : Ryan's rule
Dwyer, Trudy A. Flenady, Tracy Kahl, Julie Quinney, Loretto
Dwyer, Trudy A.
Flenady, Tracy
Kahl, Julie
Quinney, Loretto
Abstract
Introduction
Patients experience physiological changes in the hours preceding adverse medical events, and patients or their family can be the first to identify ominous signs of clinical deterioration that have gone undetected by health professionals. Patient and family activated escalation systems provide consumers access to a referral system that can address their concerns. In Queensland, this escalation system is called Ryan's Rule and once activated, triggers an independent clinical review. This study aimed to access clinicians' and activators' experiences to develop an understanding of the incidence, contributing factors, and outcomes surrounding Ryan's Rule activations.
Method
The study involved a retrospective chart review of Ryan's Rule (n = 57) activations in a regional hospital, over a 24-month period.
Results
On average, there were 2.4 activations a month. There are three major findings: first, communication issues were central to more than half the activations, 35% of cases required no clinical intervention, with communication alone sufficient to achieve resolution. Second, this initiative was valued with 65% of activators stating that they would be comfortable calling again and having access to the escalation process was reassuring and improved communication between clinicians and patients. While clinicians doubted the appropriateness of activators use of the escalation tool, 15% of patients were transferred to receive a higher level of care. Lastly, clinicians labelled activations as a ‘complaints’ as opposed to a ‘concern’ and reasoned that a ‘complaint’ did not justify a full review of the consumer's perspective for the activation.
Conclusion
Consumers who activated a Ryan's Rule were satisfied and valued the process. It provides a reassuring safety net, empowering them to speak up and initiate a clinical review. Clear communication among clinicians and between clinicians and consumers is essential. Clinicians are hesitant to fully embrace Ryan's Rule, and this discordance contributes to the failure to fully evaluate reasons for call activation.
Keywords
deteriorating patient, escalation of care, family escalation, family activation, patient and family activated escalation, systems (PFAESs), rapid response systems
Date
2020
Type
Journal article
Journal
Australian Critical Care
Book
Volume
33
Issue
Page Range
39-46
Article Number
ACU Department
School of Nursing, Midwifery and Paramedicine
Faculty of Health Sciences
Faculty of Health Sciences
Relation URI
Source URL
Event URL
Open Access Status
License
All rights reserved
File Access
Controlled