9th Conference European Sociological Association

RN22 Sociology of Risk and Uncertainty

2009-09-05 11:00:00 2009-09-05 12:30:00 Saturday, 5 September 11:00 - 12:30 Hospital Safety and Health Surveillance I Building I, 2E2

The construction of risks and uncertainties in relation to the avoidable death

In today┬┤s risk society the management of latent risk and escalation of care for the deteriorating patient at a professional and organisational level has been identified as a key issue in distributed care systems both nationally and internationally. Evidence of "failure to rescue" (failure to recognise and respond appropriately to early signs of deterioration) has been documented across clinical specialities, notably medicine, surgery and maternity. A significant proportion of these hospital deaths (including maternal and perinatal) from failure to rescue are perceived to be potentially predictable and preventable. Reflecting the current safety discourse of prediction, control and avoidance of "the accidental" (Green 2003), current national and local policy have a tendency to present the normative view that all causes of death can be determined, manipulated and postponed. Current risk management strategies are constructed around regulation of routine assessments and the governance and control of the professional management of the trajectory of the patient with acute deterioration in their condition.
Further exploration is required to understand how the distributed decision making, multiple viewpoints and conflicting knowledge bases influence the "brokering" process around deterioration. Death brokering involves processes such as drawing an acceptable line between curing or letting go, achieving a "good" death and avoiding "bad" deaths and attributing legitimate responsibility for the death (Abbott 1988). In addition, furthering our understanding of the risks associated with the uncertainty and "messy world" of the patient whose condition is deteriorating will increase our understanding of the role of these safety strategies introduced to predict and control this "avoidable" phenomena.
This paper will draw on findings from a two year project combining elements of ethnographic (observation and narrative analysis of documentation) and interview-based research from two medical settings from two UK NHS Trusts. The combination of these approaches enables assessment of street-level practice in terms of its own internal logic by examining both the conditions of work and the content of practice. Data will be presented from observations and interviews with patients, relatives and a variety of staff.