title: In-hospital mortality after serious adverse events on medical and surgical nursing units: a mixed methods study.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  Renewed attention to accurate recording, documentation and interpretation of vital signs in hospital nursing practice appears needed.
  
  
  CONCLUSIONS
  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.
authors: Faculty of Medicine and Health Sciences Division of Nursing and Midwifery Sciences, University of Antwerp, Antwerp, Belgium. koen.demeester@ua.ac.be
authors: Koen
authors: K
authors: De Meester
authors: Peter
authors: P
authors: Van Bogaert
authors: Sean P
authors: SP
authors: Clarke
authors: Leo
authors: L
authors: Bossaert
mesh_terms: D001530:Belgium; D017052:Hospital Mortality; D006784:Hospitals, Teaching; D006801:Humans; D009741:Nursing Staff, Hospital; D061214:Patient Safety; D013527:Perioperative Nursing; D012189:Retrospective Studies