Searching for Points of Failure

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Pearls for Searching for Points of Failure

1. Failure is a good thing.
2. Searching for failure means you are protecting the patient from potential harm and you are practicing safely.

Overall a good care team will always be attempting to identify areas where gaps and or failures could exist.  In the EPICC framework, it is important to note that there are four main points of failure in every emergency department visit and in day-to-day operations.  Safe patient care and good emergency department operations should consider where these failures may present and attempt to mitigate them as best as possible.

A Quick Introduction to Failures

Failure to Assess

This failure is when a nurse does not assess parameters that would be expected in a given situation.


A nurse only assesses the pain and vital signs once in their shift for a patient with chest pain.

Failure to Recognize

This failure occurs when a nurse assesses but does not recognize that what they have found is important to communicate.


A nurse has a patient with chest pain and performs a 12-lead ECG.  They do not recognize the ST elevation as a sign of an MI so do not notify the physician.

Failure to Communicate

This failure is when an issue is discovered and recognized but nobody is told about it.


A nurse discovers the signs of Sepsis, recognizes that the patient meets the Sepsis criteria but fails to notify the physician of the issue.

Failure to Escalate

This failure occurs when the nurse fails to escalate an issue that they have assessed, recognized and communicated to the appropriate person and is not satisfied with the response.


The nurse calls the physician about a deteriorating patient.  The physician states that he will come in the morning to see the patient.  The nurse, still concerned, does not escalate the situation to a supervisor or other physician.

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