Patients and families are part of the healthcare team

Delayed recognition of clinical deterioration is a common theme in sentinel events at health services around the world, including Monash Health.

In Victoria, sentinel events, preventable harms and deaths within the state’s health services are reported by Safer Care Victoria. In the five years from January 2017 to June 2021, 11 paediatric sentinel events involving emergency department care were reported, while 10 events were reported in the one year from July 2021 to June 2022.

A recent Quality Improvement project undertaken at Monash Health demonstrated that children whose parents were concerned they were getting “worse” were more likely to require admission to the Paediatric ICU (odds ratio 9.0).

Despite the simple question “Are you worried your loved one is getting worse?” helping to identify a more unwell patient cohort, it’s not currently standard practice across Monash Health, or any other health service, to routinely seek, document and respond to the concerns of patients and caregivers.

Patients and their families are well placed to identify deterioration, but their expertise is often underutilised in clinical decision-making.

Implementing a sustainable system for partnership between consumers and clinicians to identify the acutely deteriorating patient will require a new way of thinking, a shift in behaviour, from both sides.

“Let me tell you a story about a little girl called Mia.”

“Mia’s not a Monash Health patient… but Mia’s story is the same unfortunately as many, many other patients.”

Paediatric Emergency Physician Dr Erin Mills knows these stories too well, having been involved in quality improvement work around family escalation of care since late 2020. She spoke about the project on a recent Employee Forum.

Keep reading Mia’s story here

Making patients and families part of our healthcare team

Monash Health is embarking on an initiative partnering with consumers to improve the design and delivery of the Monash Health Patient and Family Escalation of Care procedure.

Over 2023-24 we will undertake a deep dive review of existing behaviours, or work as done, develop and test interventions, assess the success of the interventions, and develop a toolkit to scale the implementation out to other clinical areas and beyond.

The project will focus on three clinical settings – a paediatric emergency department, a paediatric inpatient ward, and an adult acute inpatient ward.

This work is intended to bring about permanent improved behaviours and outcomes for patients and employees.

It is an aspect of healthcare with many complexities, involving organisational culture, teamwork, workload, perceived needs of clinicians, perceived needs of families, safety climate, fear, responses to clinical uncertainty, and individual expectations about clinician and patient roles, among others.

We want our Monash Health team to be motivated and engaged with the project’s objectives.

Everyone at Monash Health, even if you’re not directly involved in the research, can start today.

Patients and families are our partners in care, and they know when their loved one is getting worse. So, when families tell you they’re worried, please listen and respond.

The information on this page will continue to grow this work continues.

Clinical Communiqué focusing on patient safety (a worthwhile read). This is an excerpt from editor Associate Professor Nicola Cunningham, introducing the topic:

“In my experience of more than two decades of reading and reviewing coronial findings, the disconnect between the concerns of families, carers, friends, and patients themselves, and a health care system’s response, is all too painfully common.”

“A breakdown in communication, an unheard voice, a silenced question, is a familiar thread that runs through almost every story.”

“Those moments may not have always been found by the coroner to be the main cause of preventable harm, but they were almost certainly a contributing factor, and undeniably, a source of long-term suffering for those whose concerns went unanswered.”