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Value of improving patient safety: health economic considerations for rapid response systems–a rapid review of the literature and expert round table

Christian Subbe Orcid Logo, Dyfrig A Hughes Orcid Logo, Sally Lewis Orcid Logo, Emily A Holmes, Cor Kalkman, Ralph So, Sumeshni Tranka, John Welch

BMJ Open, Volume: 13, Issue: 4, Start page: e065819

Swansea University Author: Sally Lewis Orcid Logo

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DOI (Published version): 10.1136/bmjopen-2022-065819

Abstract

Objectives Failure to rescue deteriorating patients in hospital is a well-researched topic. We aimed to explore the impact of safer care on health economic considerations for clinicians, providers and policymakers.Design We undertook a rapid review of the available literature and convened a round ta...

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Published in: BMJ Open
ISSN: 2044-6055 2044-6055
Published: BMJ 2023
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URI: https://cronfa.swan.ac.uk/Record/cronfa71009
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We suggest including the care needs beyond the hospital and loss of income of patients and/or their informal carers as well as sickness of healthcare staff exposed to serious adverse events in the analysis of adverse events. They are likely to have a larger health economic impact than the direct attributable cost of the hospital admission of the patient suffering the adverse event. Premorbid status of a patient is a major confounder for health economic considerations.Conclusion In order to optimise health at the population level, we must limit long-term effects of adverse events through improvement of our ability to rapidly recognise and respond to acute illness and worsening chronic illness both in the home and the hospital.</abstract><type>Journal Article</type><journal>BMJ Open</journal><volume>13</volume><journalNumber>4</journalNumber><paginationStart>e065819</paginationStart><paginationEnd/><publisher>BMJ</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>2044-6055</issnPrint><issnElectronic>2044-6055</issnElectronic><keywords/><publishedDay>17</publishedDay><publishedMonth>4</publishedMonth><publishedYear>2023</publishedYear><publishedDate>2023-04-17</publishedDate><doi>10.1136/bmjopen-2022-065819</doi><url/><notes/><college>COLLEGE NANME</college><department>Management School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>CBAE</DepartmentCode><institution>Swansea University</institution><apcterm>Another institution paid the OA fee</apcterm><funders>This work was supported by an Improvement Science Fellowship from the Health Foundation (AIMS 109280).</funders><projectreference/><lastEdited>2025-12-19T10:43:05.4428107</lastEdited><Created>2025-11-28T11:11:30.1406288</Created><path><level id="1">Faculty of Humanities and Social Sciences</level><level id="2">School of Management - Business Management</level></path><authors><author><firstname>Christian</firstname><surname>Subbe</surname><orcid>0000-0002-3110-8888</orcid><order>1</order></author><author><firstname>Dyfrig A</firstname><surname>Hughes</surname><orcid>0000-0001-8247-7459</orcid><order>2</order></author><author><firstname>Sally</firstname><surname>Lewis</surname><orcid>0000-0002-2369-2308</orcid><order>3</order></author><author><firstname>Emily A</firstname><surname>Holmes</surname><order>4</order></author><author><firstname>Cor</firstname><surname>Kalkman</surname><order>5</order></author><author><firstname>Ralph</firstname><surname>So</surname><order>6</order></author><author><firstname>Sumeshni</firstname><surname>Tranka</surname><order>7</order></author><author><firstname>John</firstname><surname>Welch</surname><order>8</order></author></authors><documents><document><filename>71009__35863__12893749f5734e02a549bf93675eb3fc.pdf</filename><originalFilename>71009.VoR.pdf</originalFilename><uploaded>2025-12-19T10:40:43.0157473</uploaded><type>Output</type><contentLength>946043</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>&#xA9; Author(s) (or their employer(s)) 2023. 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spelling 2025-12-19T10:43:05.4428107 v2 71009 2025-11-28 Value of improving patient safety: health economic considerations for rapid response systems–a rapid review of the literature and expert round table f800f55db95f30d9a4ebb0ed6e24fe8a 0000-0002-2369-2308 Sally Lewis Sally Lewis true false 2025-11-28 CBAE Objectives Failure to rescue deteriorating patients in hospital is a well-researched topic. We aimed to explore the impact of safer care on health economic considerations for clinicians, providers and policymakers.Design We undertook a rapid review of the available literature and convened a round table of international specialists in the field including experts on health economics and value-based healthcare to better understand health economics of clinical deterioration and impact of systems to reduce failure to rescue.Results Only a limited number of publications have examined the health economic impact of failure to rescue. Literature examining this topic lacked detail and we identified no publications on long-term cost outside the hospital following a deterioration event. The recent pandemic has added limited literature on prevention of deterioration in the patients’ home.Cost-effectiveness and cost-efficiency are dependent on broader system effects of adverse events. We suggest including the care needs beyond the hospital and loss of income of patients and/or their informal carers as well as sickness of healthcare staff exposed to serious adverse events in the analysis of adverse events. They are likely to have a larger health economic impact than the direct attributable cost of the hospital admission of the patient suffering the adverse event. Premorbid status of a patient is a major confounder for health economic considerations.Conclusion In order to optimise health at the population level, we must limit long-term effects of adverse events through improvement of our ability to rapidly recognise and respond to acute illness and worsening chronic illness both in the home and the hospital. Journal Article BMJ Open 13 4 e065819 BMJ 2044-6055 2044-6055 17 4 2023 2023-04-17 10.1136/bmjopen-2022-065819 COLLEGE NANME Management School COLLEGE CODE CBAE Swansea University Another institution paid the OA fee This work was supported by an Improvement Science Fellowship from the Health Foundation (AIMS 109280). 2025-12-19T10:43:05.4428107 2025-11-28T11:11:30.1406288 Faculty of Humanities and Social Sciences School of Management - Business Management Christian Subbe 0000-0002-3110-8888 1 Dyfrig A Hughes 0000-0001-8247-7459 2 Sally Lewis 0000-0002-2369-2308 3 Emily A Holmes 4 Cor Kalkman 5 Ralph So 6 Sumeshni Tranka 7 John Welch 8 71009__35863__12893749f5734e02a549bf93675eb3fc.pdf 71009.VoR.pdf 2025-12-19T10:40:43.0157473 Output 946043 application/pdf Version of Record true © Author(s) (or their employer(s)) 2023. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY- NC 4.0) license. true eng http://creativecommons.org/licenses/by-nc/4.0/
title Value of improving patient safety: health economic considerations for rapid response systems–a rapid review of the literature and expert round table
spellingShingle Value of improving patient safety: health economic considerations for rapid response systems–a rapid review of the literature and expert round table
Sally Lewis
title_short Value of improving patient safety: health economic considerations for rapid response systems–a rapid review of the literature and expert round table
title_full Value of improving patient safety: health economic considerations for rapid response systems–a rapid review of the literature and expert round table
title_fullStr Value of improving patient safety: health economic considerations for rapid response systems–a rapid review of the literature and expert round table
title_full_unstemmed Value of improving patient safety: health economic considerations for rapid response systems–a rapid review of the literature and expert round table
title_sort Value of improving patient safety: health economic considerations for rapid response systems–a rapid review of the literature and expert round table
author_id_str_mv f800f55db95f30d9a4ebb0ed6e24fe8a
author_id_fullname_str_mv f800f55db95f30d9a4ebb0ed6e24fe8a_***_Sally Lewis
author Sally Lewis
author2 Christian Subbe
Dyfrig A Hughes
Sally Lewis
Emily A Holmes
Cor Kalkman
Ralph So
Sumeshni Tranka
John Welch
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container_title BMJ Open
container_volume 13
container_issue 4
container_start_page e065819
publishDate 2023
institution Swansea University
issn 2044-6055
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doi_str_mv 10.1136/bmjopen-2022-065819
publisher BMJ
college_str Faculty of Humanities and Social Sciences
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hierarchy_top_title Faculty of Humanities and Social Sciences
hierarchy_parent_id facultyofhumanitiesandsocialsciences
hierarchy_parent_title Faculty of Humanities and Social Sciences
department_str School of Management - Business Management{{{_:::_}}}Faculty of Humanities and Social Sciences{{{_:::_}}}School of Management - Business Management
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description Objectives Failure to rescue deteriorating patients in hospital is a well-researched topic. We aimed to explore the impact of safer care on health economic considerations for clinicians, providers and policymakers.Design We undertook a rapid review of the available literature and convened a round table of international specialists in the field including experts on health economics and value-based healthcare to better understand health economics of clinical deterioration and impact of systems to reduce failure to rescue.Results Only a limited number of publications have examined the health economic impact of failure to rescue. Literature examining this topic lacked detail and we identified no publications on long-term cost outside the hospital following a deterioration event. The recent pandemic has added limited literature on prevention of deterioration in the patients’ home.Cost-effectiveness and cost-efficiency are dependent on broader system effects of adverse events. We suggest including the care needs beyond the hospital and loss of income of patients and/or their informal carers as well as sickness of healthcare staff exposed to serious adverse events in the analysis of adverse events. They are likely to have a larger health economic impact than the direct attributable cost of the hospital admission of the patient suffering the adverse event. Premorbid status of a patient is a major confounder for health economic considerations.Conclusion In order to optimise health at the population level, we must limit long-term effects of adverse events through improvement of our ability to rapidly recognise and respond to acute illness and worsening chronic illness both in the home and the hospital.
published_date 2023-04-17T05:31:16Z
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