title: Failure events in transition of care for surgical patients.
abstract: BACKGROUND
  Unexpected clinical deterioration (failure events) in surgical patients on standard nursing units (WARDs) could have a significant impact on eventual survival. We sought to investigate failure events requiring intensive care (surgical ICU [SICU]) transfer of surgical patients on WARDs in a single-center academic setting.
  
  
  METHODS
  Surgical patients admitted to WARDs over a 12-month period, who developed failure events, were retrospectively reviewed. Time to deterioration since WARD arrival, clinical factors, notification chain, and outcomes were identified. A physician review panel determined the preventability of failure events.
  
  
  RESULTS
  Ninety-eight patients experienced 111 failure events requiring SICU transfer. Most patients (85%) were emergency admissions. Of 111 events, 90% had been previously discharged from an SICU or a postanesthesia care unit (PACU). Recognition of failure was by nursing (54%) and on routine physician rounds (34%). Rapid response or code blue alone was less common (12%). A second physician notification was needed in 29%, with delays due to failure to identify severity of illness. Most commonly, respiratory events prompted notification (77 of 111, 69%). Overall mortality was 26 of 98 (27%). Median time to failure was 2 days and was associated with early transfer from the SICU or PACU. Rapid response or code blue activation was associated with higher mortality than physician notification.
  
  
  CONCLUSIONS
  Patients most at risk for WARD failures were those with acute surgical emergencies or recently discharged from the SICU or PACU. Respiratory complications were the most common cause of WARD failure events. Many early failures may have been due to premature transfer from the SICU or PACU. Failure events on WARDs can have lethal consequences. Awareness, monitoring, and communication are important components of preventative measures.
authors: Department of Surgery, University of Mississippi Medical Center, Jackson, MS. Electronic address: thelling@umc.edu.
authors: Thomas S
authors: TS
authors: Helling
authors: Department of Surgery, University of Mississippi Medical Center, Jackson, MS.
authors: Larry C
authors: LC
authors: Martin
authors: Department of Surgery, University of Mississippi Medical Center, Jackson, MS.
authors: Magdeline
authors: M
authors: Martin
authors: Department of Surgery, University of Mississippi Medical Center, Jackson, MS.
authors: Marc E
authors: ME
authors: Mitchell
mesh_terms: D000368:Aged; D003422:Critical Care; D017052:Hospital Mortality; D006757:Hospital Units; D006801:Humans; D010343:Patient Admission; D010351:Patient Discharge; D010360:Patient Transfer; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D011184:Postoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure