Reducing avoidable deaths from failure to rescue: a discussion paper.
OBJECTIVE
This article proposes a radical new approach to the monitoring and governance of services, and the education and training of nurses to meet 'failure to rescue' requirements.


BACKGROUND
Healthcare policy in the UK that seeks to ensure safe and effective services for the acutely ill has largely failed, resulting in adult patients dying unnecessarily. Despite grand rhetoric, UK governments have distanced themselves from implementation, resulting in patchy localised developments and creating inconsistent service responses.


METHODS
This article draws on a review of research and UK policy literature and best international practice to propose a new national framework approach that combines competency development, governance and performance monitoring to address 'failure to rescue' shortcomings.


CONCLUSIONS
Paramount is a nationally agreed and fit-for-purpose competency tool using simulation to assess staff in order to improve recognition of the deteriorating patient. Service improvements should include increased investment in telemedicine; service performance should be communicated through publicly available ratings and overseen by patient panels; and governance will require strengthening through enhanced Care Quality Commission/Monitor input, which should be linked to the maintenance of foundation trust status.


CONCLUSIONS
Health professional bodies, regulators, providers and the Government must work together to strengthen the safety and effectiveness of acute services. This will require investment in staff competency and enhancement of the governance to ensure services consistently meet public expectations and reduce unnecessary deaths.
Critical Care Nurse, Guy's and St Thomas' NHS Foundation Trust, London.
James
J
Waldie
Executive Dean, Bournemouth University.
Stephen
S
Tee
Lecturer, Florence Nightingale Faculty of Nursing and Midwifery, King's College London.
Tina
T
Day
D002983:Clinical Competence; D064648:Critical Care Nursing; D016638:Critical Illness / Q000451:nursing*; D004506:Education, Nursing; D000067248:Failure to Rescue, Health Care; D006291:Health Policy; D006801:Humans; D058996:Quality Improvement; D011787:Quality of Health Care; D006113:United Kingdom
Critical care; Critical illness; Nursing staff; Policy; Political implications