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Review
. 2023 Dec 1;36(6):676-682.
doi: 10.1097/ACO.0000000000001312. Epub 2023 Sep 28.

Initiatives to detect and prevent death from perioperative deterioration

Linda M Posthuma  1 , Benedikt Preckel  2   3
Affiliations
Review

Initiatives to detect and prevent death from perioperative deterioration

Linda M Posthuma et al. Curr Opin Anaesthesiol. .

Abstract

Purpose of review: This study indicates that there are differences between hospitals in detection, as well as in adequate management of postsurgical complications, a phenomenon that is described as 'failure-to-rescue'.In this review, recent initiatives to reduce failure-to-rescue in the perioperative period are described.

Recent findings: Use of cognitive aids, emergency manuals, family participation as well as remote monitoring systems are measures to reduce failure-to-rescue situations. Postoperative visit of an anaesthesiologist on the ward was not shown to improve outcome, but there is still room for improvement of postoperative care.

Summary: Improving the complete emergency chain, including monitoring, recognition and response in the afferent limb, as well as diagnostic and treatment in the efferent limb, should lead to reduced failure-to-rescue situations in the perioperative period.

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Conflict of interest statement

L.M. Posthuma: none.

B. Preckel: previously member of the Advisory Board of Sensium Healthcare, United Kingdom.

Figures

FIGURE 1
FIGURE 1
Development of complications and level of monitoring (previously published in [6]). While the level of monitoring is high during the time in the operating room (OR), it declines significantly during the stay of a patient on the post-anaesthesia care unit (PACU) and is low on the surgical ward, whereas possible complications have the highest incidence on the ward on days 2 and 3 after the operation.
Box 1
Box 1
no caption available
FIGURE 2
FIGURE 2
The afferent and efferent arm of a Rapid Response System. The afferent part of this emergency chain contains aspects for monitoring of vital signs and patient's wellbeing, recognition of deviations and adequate response to the deviation. The efferent part consists of indicated diagnostic procedures as well as adequate treatment (medication, interventional of surgical procedures and so on).
See this image and copyright information in PMC

References

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