Is your hospital invested in your safety?

The word "safety" has multiple connotations when applied to hospitals and other healthcare facilities. In developing countries like Bangladesh, there could be concerns about structural integrity of buildings, personal security from assault, or even confidence in the financial system used for payment. These and other similar issues abound, but are easily discerned by many users of the healthcare system who can take precautionary measures against them. There is, however, one aspect of safety that people take for granted, or even fail to consider at all, when it comes to hospitals: their health. We assume that in an environment that caters to specialist healthcare, we need not worry about the intricacies of various diseases and their effects, as skilled practitioners are there to do that for us. But are we wise to do so?

The first issue of safety is recognition. It is reasonably straightforward to identify a sick patient—this is what hospitals are for. However, how efficient are our hospitals in identifying a deteriorating patient? In other words, how effective are they in picking up the cues of active progression of pathology in an erstwhile well patient? Most facilities will have their nursing staff make regular observations and document these readings in the patient notes. This mundane task invariably turns into nothing more than a data collection exercise, and it is for this reason why the "medical early warning scores" have been developed.

An individual low reading of oxygen saturation or a high reading of heart rate may not trigger the mind to think that a patient's condition is changing, but when these vital signs are grouped together and attributed a score, trends of deterioration can be picked up. When, in a space of a few hours, a patient's early warning score starts to creep up, healthcare workers will know that they need to call for extra help when a pre-set score is triggered.

This leads to the second issue of safety: Who do you call for help? The wards or on-duty doctors are usually the first ones to be called when problems arise. Although capable, these doctors are on the lowest tier of the medical hierarchy and responsible only for dealing with minor healthcare problems of their patients. The more senior doctors do visit their patients during rounds, but are otherwise occupied with other commitments—such as running clinics, performing medical procedures, etc.—and so may be difficult to get hold of when matters take a turn for the worse.

There is also the issue of patients' condition deteriorating in a non-medical ward such as surgery or gynaecology, where the input of a physician is vital. At the critical end of the spectrum, hospitals in many countries have a "code" system in which a code blue is put out for a patient in extreme distress, and experts in the vicinity rush to help. Although an ad hoc arrangement, this can improve patient outcomes.

However, to improve safety, hospitals need to invest in a dedicated rapid response team. This is a group of specialist doctors who are trained to deal with acutely unwell patients all across the hospital and are allocated to this task daily. They remain prepared throughout their shift and have access to emergency kit bags, which they carry with them to a call. The hospital selects the team from relevant specialties like medicine, anaesthesia, emergency, and critical care, and provides the team with regular training.

In most cases, there is a dedicated number to call to activate this team. In the UK, for example, 2222 is the standardised rapid response hotline. Having this number standardised, as well as prominently displayed in all areas, is essential not just for allowing the public to activate this call when faced with a hospital emergency, but it also ensures that despite staff turnover, all staff members are aware of what number to call.

So, how would you know if your hospital is invested in your safety? There are two tell-tale signs: 1) The presence of a well-displayed medical early warning score that is designed to trigger a response; and 2) Guidance on how to contact the rapid response team, situated on the other end of every accessible telephone. Setting this infrastructure into place does incur a cost. But the cost of averting a medical crisis is much less, for both the hospital and the patient, than dealing with a critical care emergency that was initially missed.

Dr Mir Saaduddin Ahmad is a specialist in emergency medicine and academic director at Dr Nizam Medical Centre in Dhaka.