Failure to rescue following emergency surgery: a FRAM analysis of the management of the deteriorating patient

Sujan, M., Bilbro, N., Ross, A. , Earl, L., Ibrahim, M., Bond-Smith, G., Ghaferi, A., Pickup, L. and McCulloch, P. (2022) Failure to rescue following emergency surgery: a FRAM analysis of the management of the deteriorating patient. Applied Ergonomics, 98, 103608. (doi: 10.1016/j.apergo.2021.103608) (PMID:34655965)

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Background: Failure to rescue (FTR) denotes mortality from post-operative complications after surgery with curative intent. High-volume, low-mortality units have similar complication rates to others, but have lower FTR rates. Effective response to the deteriorating post-operative patient is therefore critical to reducing surgical mortality. Resilience Engineering might afford a useful perspective for studying how the management of deterioration usually succeeds and how resilience can be strengthened. Methods: We studied the response to the deteriorating patient following emergency abdominal surgery in a large surgical emergency unit, using the Functional Resonance Analysis Method (FRAM). FRAM focuses on the conflicts and trade-offs inherent in the process of response, and how staff adapt to them, rather than on identifying and eliminating error. 31 semi-structured interviews and two workshops were used to construct a model of the response system from which conclusions could be drawn about possible ways to strengthen system resilience. Results: The model identified 23 functions, grouped into five clusters, and their respective variability. The FRAM analysis highlighted trade-offs and conflicts which affected decisions over timing, as well as strategies used by staff to cope with these underlying tensions. Suggestions for improving system resilience centred on improving team communication, organisational learning and relationships, rather than identifying and fixing specific system faults. Conclusion: FRAM can be used for analysing surgical work systems in order to identify recommendations focused on strengthening organisational resilience. Its potential value should be explored by empirical evaluation of its use in systems improvement.

Item Type:Articles
Additional Information:This work was funded in part by the National Institute for Health Research (NIHR) [Programme Grant for Applied Research NIHR200868].
Glasgow Author(s) Enlighten ID:Ross, Dr Alastair
Authors: Sujan, M., Bilbro, N., Ross, A., Earl, L., Ibrahim, M., Bond-Smith, G., Ghaferi, A., Pickup, L., and McCulloch, P.
College/School:College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Dental School
Journal Name:Applied Ergonomics
ISSN (Online):1872-9126
Published Online:14 October 2021
Copyright Holders:Copyright © 2021 Elsevier Ltd.
First Published:First published in Applied Ergonomics 98:103608
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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