Enabling Safer Care: Evidence-Based Implementation of Escalation of Care Strategies in an Academic Healthcare System

Each year, 70,000 patients are harmed in hospital, despite decades of trying to make the healthcare system safer for them. This harm is not intentional and can be a result of miscommunication between patients' healthcare team. Sometimes, patients' health worsens and if that isn't noticed and reported by healthcare workers it is called a failure to escalate care. Escalating care means a healthcare worker notices a change in a patients' condition and reports it. Sinai Health (SH) is committed to making healthcare safer for their patients by trying to eliminate harm from not escalating care. SH began addressing escalation of care, but paused this work to respond to the pandemic. My project will implement escalation of care strategies at SH to provide better and safer care. The healthcare system changed because of COVID-19, so I will first update our escalation of care strategies to account for the latest research on COVID-19 and review other hospitals' strategies to ensure that SH is meeting the same standards. One reason why healthcare workers don't escalate care is because they are afraid of being criticized or humiliated. Psychological safety (PS) is defined as how safe people feel about speaking up at work. PS is important for escalating care because without it, healthcare workers might not speak up. Also, speaking up is harder when managers and workers don't feel the same level of PS. I plan to interview healthcare workers and their managers individually to find out about their PS to see if it matches and see if that changes how they escalate care. The COVID-19 pandemic has been difficult for healthcare workers, so I will also ask questions about how the pandemic may have changed their feelings around escalating care. Combing the knowledge from my interviews with the updated escalation of care strategies, I will create an implementation plan for SH. I will share my work with SH management, SH's partner organizations and with the academic research community.