Can you hear me? Analysis of a Queensland patient-initiated escalation process and the importance of communication in surgical care.

Abstract

Ryan's Rule is a three-step escalation process established by Queensland Health whereby patients, their families and carers can escalate concerns if a patient's health is worsening or not improving as expected. This study analysed the incidence, causes and outcomes of Ryan's Rule cases involving patients admitted under various surgical specialties across Queensland. A retrospective analysis was undertaken of cases wherein Ryan's Rule was invoked by surgical patients between 2016 and 2021. The analysis focused on rationale for invoking Ryan's Rule, clinical actions undertaken, outcomes and patient feedback. The study analysed 364 activations of Ryan's Rule among surgical patients admitted across ten Queensland Health hospitals. The common causes for invoking Ryan's Rule were concern or disagreement regarding the management plan (39%), poor understanding of the care plan (32%) and feeling that concerns were not being heard (35%). Less than 1 % of cases (0.8%) met early warning criteria for deterioration, and only 0.5% required admission to ICU. The majority of Ryan's Rule cases (92%) were resolved through discussion between the treating surgical team, the patient and their representatives. In 74% of cases, the management plan did not change following the Ryan's Rule review. Communication is the overwhelming theme throughout the Ryan's Rule cases invoked by surgical patients. The majority of Ryan's Rules cases were initiated by issues in communication and understanding between clinicians and patients. The vast majority of cases were resolved by surgical teams establishing and maintaining clear communication with patients, their families and carers.