Tuesday, 29 October 2013

Auditing Rescue rates - one for the Chief Inspector of Hospitals

I have recently completed 3 days of teaching on the Ccrisp (Care of the Critically Ill Surgical Patient) Course in Sheffield. This must be close to my 20th + course I have taught on and the changes that I have observed over the past 13 years have prompted me to write this post.
When compared to 13 years ago, Candidates are more likely to be graduates of British and EU med schools and less likely to be graduates of non EU schools.
Candidates are now so much better and far more likely to pass the course with flying colours. It is now very rare for anyone to fail the course. 
Candidates are younger and more junior than they were 13 years ago. A significant proportion of them are F2 and CT1 doctors. They are therefore less experienced but seem in theory ( based on my observations) to be better prepared to deal with the deteriorating patient - certainly better than I was at the same career stage. When I trained nearly thirty years ago, dealing with deteriorating patients, used to fill me with abject terror. The substitution of years of apprenticeship with good quality scenario based teaching courses has despite the gloomy predictions of grumpy old men like myself has produced doctors who seem to be much better prepared to deal with ill patients - this is, assuming good simulated performance on the course reflects real life and yet anecdotal evidence suggest worsening care in hospitals  - who or what to believe.
A number of studies now suggest that failure to rescue is what distinguishes hospitals with poor outcomes after major surgery from those with good ones.
It seems to me that a worthwhile rolling audit of performance when dealing with the deteriorating patient is called for - as is a proper validation and investigation of the worth of courses like the Ccrisp course.
One for the Inspector of Hospitals to ponder!