Standardised communication tools as an aide to facilitating "calling for help" and the escalation of care: the importance of understanding professional boundary work
NIHR Patient Safety and Service Quality Research Centre King's College, London London, UK
NIHR Patient safety and Service Quality Research Centre King's College, London London, UK
International patient safety policy documents explicitly acknowledge that tackling ?failure to rescue? (failure to recognise and respond appropriately to early signs of deterioration) has become a key international and national patient safety policy objective.
These reports note evidence of ?failure to rescue? across acute medicine, surgery and maternity and cite failure to appreciate severity of illness and sub-optimal treatment; wrong diagnoses, and failure of junior staff to diagnose or refer a case to a more senior colleague often results in unanticipated admissions to the intensive care unit (ICU), increased length of hospital stay, cardiac arrest or death.
There is widespread recognition that ?failure to rescue? is often linked with difficulties relaying and interpreting information across inter-professional boundaries which have been shown to contribute to care management problems. Standardised communication tools have been recommended as a means of improving the management of latent risk and escalation of care for the deteriorating patient. In the case of the nurse or midwife, the tool aims to enable the transmission of concise, salient information, licensing and empowering the individual to overcome established hierarchies in speaking out and asking for help.
Thus these tools are designed to override occupational and power hierarchies by facilitating transfer across organisational and professional boundaries. However, there has been little scrutiny of how such strategies are enacted in the workplace and of the response of the recipient. Draw on our research which is exploring the implementation of such communication tools in acute medical and maternity settings, we discuss how sociological literature on boundary work and inter-professional negotiation would suggest that the implementation of such communication tools may be more problematic than assumed.
To be submitted to Upsetting the health professional workforce: collaborative care and professional
boundaries ? joint session with RN16 "Sociology of Health and Illness"