title: The social practice of rescue: the safety implications of acute illness trajectories and patient categorisation in medical and maternity settings.
abstract: The normative position in acute hospital care when a patient is seriously ill is to resuscitate and rescue. However, a number of UK and international reports have highlighted problems with the lack of timely recognition, treatment and referral of patients whose condition is deteriorating while being cared for on hospital wards. This article explores the social practice of rescue, and the structural and cultural influences that guide the categorisation and ordering of acutely ill patients in different hospital settings. We draw on Strauss et al.'s notion of the patient trajectory and link this with the impact of categorisation practices, thus extending insights beyond those gained from emergency department triage to care management processes further downstream on the hospital ward. Using ethnographic data collected from medical wards and maternity care settings in two UK inner city hospitals, we explore how differences in population, cultural norms, categorisation work and trajectories of clinical deterioration interlink and influence patient safety. An analysis of the variation in findings between care settings and patient groups enables us to consider socio-political influences and the specifics of how staff manage trade-offs linked to the enactment of core values such as safety and equity in practice.
authors.affiliation: Division of Women's Health, King's College London, London, UK.
authors.forename: Nicola
authors.initials: N
authors.lastname: Mackintosh
authors.affiliation: Division of Women's Health, King's College London, London, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Sandall
mesh_terms: D000884:Anthropology, Cultural; D002983:Clinical Competence; D017598:Efficiency, Organizational; D004638:Emergency Treatment / Q000592:standards*; D000067248:Failure to Rescue, Health Care; D005260:Female; D006748:Hospital Departments / Q000458:organization & administration; D006786:Hospitals, Urban / Q000458:organization & administration; D006801:Humans; D009775:Obstetrics and Gynecology Department, Hospital / Q000458:organization & administration* / Q000592:standards; D061214:Patient Safety; D011247:Pregnancy; D011787:Quality of Health Care / Q000458:organization & administration* / Q000592:standards; D012959:Socioeconomic Factors; D012962:Sociology, Medical; D013997:Time Factors; D006113:United Kingdom
keywords: ethnography; hospitals; maternity services; quality of care; risk; safety