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Lynette Adams presented this at the 2014 Managing the Deteriorating Patient Conference. The conference discussed the latest strategies to recognise and respond to the acute patient in clinical deterioration. You can find out more about next year's conference at http://bit.ly/1sjQubi
Citation preview
Ryan’s Rule:
Patient, family and carer
escalation
Lynette Adams
Patient Safety Unit
Overview
• Background
• Method
• Results
• Evaluation
Background
• Ryan Saunders died in a
Queensland Health facility
2007
• Coroner found his death to
be in “all likelihood
preventable”
• Commitment to Saunders
family-create Ryan’s Rule
Method
• Literature review
• Liaison with NSW & ACT
• Clinician and consumer focus group
• Extensive statewide consultation
• Development of resources
• Consumer testing (n=116)
• Pre-implementation piloting
Focus group
• Feb 2012
– 8 consumers
– 24 Clinicians/ clinical leads (23 sites)
– 6 Corporate staff
• Development of core principles to
underpin system
Resource development
• Consumer
– Brochure
– Posters
• Staff
– Model guidelines
– Staff information sheet
– Education
– Web banners,spotlights
An idea
• Why not introduce a single call number?
• Investigation of options
• 13HEALTH – current 24/7 advice line
• Call centre staffed by all of government
centre
Consultation
• Brochure
– reviewed across state
– Clinicians- extensive consultation and 2
working groups- much debate over language
– Consumer testing-116 patients/ family
members/ carers
Process
• 3 step process
• Single state-wide phone
number
• Warm transfer of call
• Email notification to
Patient Safety Unit and
facility
• Evaluation online via
MARS
Facility requirements
• Identify 3 positions to take call- available
24/ 7
• Educate at least 80% of staff
• Governance
– Accountable committee
– Approved internal procedure and
documentation
• Pass testing of system
• 67 facilities
• 8 HHSs
• Remainder
state by
end 2014
Results• Commenced in Dec 2013
• 79 calls to date (7.9/mth) (email
notification)
• Evaluation within 3 week days
• Statewide data capture- online data-MARS
• 52 calls evaluated
• Calls -DMS, Bed manager, ICU liaison,
CTC, MET, DON, EDMS
0 10 20 30 40 50 60
Family
Patient
Other- staff
Other- partner
Carer
Other- friend
Caller
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Caller's needs Patient's needs Use Ryan's Rule again
Feedback
Negative Neutral Positive
0 5 10 15 20 25
No clinical intervention, remained on ward
Other - specify
Clinical intervention, remained on ward
Transfer to another facility
Transferred to another ward
Retrieval to another facility
Transferred to ICU/HDU/CCU
Outcome of Ryan's Rule call
0
5
10
15
20
25
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Time of call day of week- In hours/ Out of hours
In hours Out of hours
In hrs = 0800 to 1700
Out hrs = 1701 to 0759
Calls
• Appropriate use
• Initial response from facilities that the calls
aren’t true Ryan’s Rule calls if no clinical
deterioration
• After evaluation a few calls shifts to
understand and value the use of Ryan’s
Rule
• Ave 45 mins r/v patient
• 2 out 52 calls met review criteria
Calls
• Initially concerns around communication
but in family meeting apparent wife
struggling with husband’s deteriorating
condition.
– Social work support for end of life care
• Concerned about husband -need to be in
tertiary hospital due to spinal injury-
– on review patient transferred
Calls
• Concerned her husband’s condition was
deteriorating (in ED)- On review
– CT scan,
– Admission to HDU, and then
– Retrieval to another facility
– Positive feedback from caller
Case Study
• A woman in labour requested a Ryan’s
Rule review “they’re not listening to me”
and she felt she was “going to have a
heart attack”.
• On r/v- BP190/115 mmHg – emergency
criteria & without an emergency call/
medical review for a number hours.
• Good outcome for mum and baby
Case study cont.
• Analysis -midwives had assumed her
hypertension was related to anxiety so did
place an emergency call or seek medical
input
• The patient had a history of mild
depression
Challenges
• Refining process at 13HEALTH- copying
facilities
• Initial negative feedback from a few sites
– You should take down some posters, too
many calls (after 2nd call)
– Not a “true” Ryan’s Rule call
– Can you screen the calls (to ensure patient
has deteriorated)?
Some comments
• You should take down some posters, we
must have too many up (after 2nd call)
• Not a “true” Ryan’s Rule call
• Can you screen the calls (to ensure
patient has deteriorated)
Ongoing work
• Feedback on why call was required
• Feedback on why caller/patient
dissatisfied with Ryan’s Rule Clinical
Evaluation
Acknowledgements
• Shaune Gifford, Kate Smith and other
PSU staff
• Clinicians and consumers across Qld
• CEC NSW & ACT Health
Questions
???