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Evaluation of a patient and family activated escalation system: Ryan's Rule

journal contribution
posted on 05.02.2020, 00:00 by Trudy DwyerTrudy Dwyer, Tracy FlenadyTracy Flenady, Julie KahlJulie Kahl, LT Quinney
Introduction: Patients experience physiological changes in the hours preceding adverse medical events, and patients or their family can be the first to identify ominous signs of clinical deterioration that have gone undetected by health professionals. Patient and family activated escalation systems provide consumers access to a referral system that can address their concerns. In Queensland, this escalation system is called Ryan's Rule and once activated, triggers an independent clinical review. This study aimed to access clinicians’ and activators’ experiences to develop an understanding of the incidence, contributing factors, and outcomes surrounding Ryan's Rule activations. Method: The study involved a retrospective chart review of Ryan's Rule (n = 57) activations in a regional hospital, over a 24-month period. Results: On average, there were 2.4 activations a month. There are three major findings: first, communication issues were central to more than half the activations, 35% of cases required no clinical intervention, with communication alone sufficient to achieve resolution. Second, this initiative was valued with 65% of activators stating that they would be comfortable calling again and having access to the escalation process was reassuring and improved communication between clinicians and patients. While clinicians doubted the appropriateness of activators use of the escalation tool, 15% of patients were transferred to receive a higher level of care. Lastly, clinicians labelled activations as a ‘complaints’ as opposed to a ‘concern’ and reasoned that a ‘complaint’ did not justify a full review of the consumer's perspective for the activation. Conclusion: Consumers who activated a Ryan's Rule were satisfied and valued the process. It provides a reassuring safety net, empowering them to speak up and initiate a clinical review. Clear communication among clinicians and between clinicians and consumers is essential. Clinicians are hesitant to fully embrace Ryan's Rule, and this discordance contributes to the failure to fully evaluate reasons for call activation. © 2019 Australian College of Critical Care Nurses Ltd

Funding

Category 4 - CRC Research Income

History

Volume

33

Issue

1

Start Page

39

End Page

46

Number of Pages

8

eISSN

1878-1721

ISSN

1036-7314

Publisher

Elsevier, USA

Peer Reviewed

Yes

Open Access

No

Acceptance Date

07/01/2019

External Author Affiliations

Queensland Health; Pell Centre, Ballarat, Vic.

Era Eligible

Yes

Journal

Australian Critical Care