In-hospital mortality after serious adverse events on medical and surgical nursing units: A mixed methods study

Koen De Meester, Peter Van Bogaert, Sean Clarke, Leo Bossaert

Research output: Contribution to journalArticle

Abstract

Aims and objectives. To investigate the circumstances of nursing care eight hours before serious adverse events (=SAE's) on medical and surgical nursing units with subsequent in-hospital mortality in order to identify the extent to which these SAE's were potentially preventable. Background. The prevention of SAE 's in acute care is coming under increasing scrutiny, while the role nursing care plays in the prevention of acute critical deterioration of patients is unclear. Methods. Retrospective review of patient records of 63 SAE's in a Belgian teaching hospital where death was the final outcome following a cardiac arrest team call or unplanned ICU admission from an acute care unit. Data from chart reviews were combined with data regarding working conditions on the nursing unit at the time of the events and experts' opinions regarding the preventability of the outcomes. Finally, a pilot survey of staff nurses about their experiences with deteriorating patients and knowledge of vital signs and call criteria was conducted independently of the chart abstractions and case reviews. Results. Experts were almost five times more likely to designate a case as potentially preventable when a cardiac arrest team call was the terminal event and were 40% less likely to designate a case as potentially preventable when more observations were documented in patient records. Survey results revealed that nurses were often unaware that their patients were deteriorating before the crisis. Nurses also reported threshold levels for concern for abnormal vital signs that suggested they would call for assistance relatively late in clinical crises. Conclusion. Renewed attention to accurate recording, documentation and interpretation of vital signs in hospital nursing practice appears needed. Relevance to clinical practice. Timely detection of deteriorating patients to assist staff to improve their outcomes appears to be jeopardised by a number of practices and factors and merits deeper study.

Original languageEnglish (US)
Pages (from-to)2308-2317
Number of pages10
JournalJournal of Clinical Nursing
Volume22
Issue number15-16
DOIs
StatePublished - Aug 1 2013

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Hospital Mortality
Vital Signs
Nurses
Nursing Care
Heart Arrest
Nursing
Expert Testimony
Teaching Hospitals
Documentation
Medical-Surgical Nursing

Keywords

  • Adverse events
  • Early interventions
  • In-hospital mortality
  • Mixed methods
  • Patient deterioration
  • Patient safety
  • Retrospective analyse
  • Staff awareness
  • Vital sign

ASJC Scopus subject areas

  • Nursing(all)

Cite this

In-hospital mortality after serious adverse events on medical and surgical nursing units : A mixed methods study. / De Meester, Koen; Van Bogaert, Peter; Clarke, Sean; Bossaert, Leo.

In: Journal of Clinical Nursing, Vol. 22, No. 15-16, 01.08.2013, p. 2308-2317.

Research output: Contribution to journalArticle

De Meester, Koen ; Van Bogaert, Peter ; Clarke, Sean ; Bossaert, Leo. / In-hospital mortality after serious adverse events on medical and surgical nursing units : A mixed methods study. In: Journal of Clinical Nursing. 2013 ; Vol. 22, No. 15-16. pp. 2308-2317.
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