Failure to Monitor in Healthcare: A Preventable Cause of Patient Harm

Failure to monitor is a one of the most common forms of medical malpractice.

Introduction

In healthcare, timely monitoring of a patient’s condition is critical. The failure to detect and respond to subtle changes in a patient’s status can lead to rapid deterioration, permanent injury, or even death. Known as "failure to monitor," this form of medical negligence remains a frequent cause of preventable harm and malpractice litigation. Despite the growing adoption of remote monitoring technologies and predictive algorithms, human oversight and timely clinical judgment are still indispensable.

This blog will examine the causes and consequences of failure to monitor in healthcare, highlight technologies like PeraTrend and the Rothman Index that aim to prevent patient decline, and share what families and patients can do to help avoid these outcomes. We’ll also describe how EvaluCare helps families uncover whether monitoring failures played a role in a loved one's decline and what steps they can take to pursue resolution.

What is Failure to Monitor?

Failure to monitor refers to the neglect to properly observe a patient’s vital signs, symptoms, or lab values and respond appropriately. This includes:

• Infrequent or missed vital sign checks (heart rate, blood pressure, oxygen levels, etc.)

• Ignoring lab results or imaging findings

• Not following up on symptoms of deterioration

• Delayed response to warning signs

• Insufficient post-operative monitoring

  
  

Monitoring is especially critical for patients in post-surgical care, those with unstable conditions, or those on medications requiring close observation. Challenges are increase with patient with sleep apnea, on medications that can cause respiratory depression, or with chronic conditions like congestive heart failure, chronic obstructive pulmonary disease.

Technological Advances: PeraTrend and the Rothman Index

Technology has enhanced clinicians' ability to predict patient decline. Tools like PeraTrend, which uses the Rothman Index, continuously analyze data from the electronic health record (EHR) to produce a score reflecting a patient’s overall condition. It can predict patient decline before a clinician can observe it.

The Rothman Index incorporates:

• Vital signs

• Lab results

• Nursing assessments

This composite score allows clinicians to identify trends and intervene before a patient crashes. In many hospitals, automated alerts notify providers of a worsening Rothman Index, prompting reassessment.

However, while such technologies offer promising early warning systems, they are not failsafe. Algorithms depend on accurate, up-to-date data. If vital signs are not recorded promptly, or if alerts are ignored due to alarm fatigue or staffing shortages, patients can still be at risk. And lastly, and most importantly there needs to be clinical care processes that ensure the data in the Rothman Index is reviewed routinely.

Common Lawsuits Related to Failure to Monitor

Numerous lawsuits have exposed the dangers of inadequate monitoring:

• Florida, 2021: A woman recovering from surgery showed abnormal vitals that went unaddressed. She suffered cardiac arrest and severe brain injury. A $9.2 million settlement was awarded.

• Illinois, 2019: A hospital failed to monitor a diabetic patient post-surgery. Blood sugar spiked, leading to ketoacidosis and death. The court ruled in favor of the family, citing failure to monitor glucose levels.

• California, 2020: A patient on opioids for post-op pain was not properly monitored for respiratory depression. The patient died in his sleep. The case settled for $5.1 million.

  
  

These cases are a small sampling that underscore the legal and ethical obligation of providers to monitor patients continuously and take action when necessary. When actions are not taken negligence is straightforward.

Remote Monitoring: An Improvement, Not a Solution

Remote monitoring devices, wearable sensors, and telemetry systems have improved surveillance, especially for patients at home or in rehabilitation centers. These systems track:

• Heart rate

• Oxygen saturation

• Blood pressure

• Sleep patterns

  
  

While they offer real-time data and can alert providers to significant changes, they are not foolproof. Issues include:

• Device malfunctions

• Missed alerts

• Delayed data transmission

• Lack of clinical follow-up on flagged data

  
  

Technology is only as good as the system supporting it. If staff fail to act on alerts or are too overwhelmed to intervene, outcomes do not improve. As our healthcare system moves to embrace immerging technology for remote monitoring, it opens up a boat load of challenges and potential systems issues, that are often not discovered until after adoption. The point between adoption and refinement puts patients at the most risk.

Types of Negligence That Lead to Failure to Monitor

Negligence in monitoring can take many forms:

1. Inadequate Staffing: Overworked or insufficiently staffed units may miss changes in patient status.

2. Poor Handoffs: Miscommunication during shift changes or transfers can lead to missed information.

3. Failure to Escalate: Nurses or aides may notice signs of decline but fail to inform physicians.

4. Documentation Gaps: Missing or incorrect documentation can prevent the care team from seeing trends.

5. Ignoring Family Concerns: Families may notice subtle changes in behavior or status that are dismissed by staff.

   
   

What Families Can Do to Help Prevent Failure to Monitor

1. Ask About Monitoring Protocols:

   • How often are vital signs checked?

   • Who is responsible for responding to changes?

     
     

2. Watch for Changes:

   • Monitor speech, breathing, movement, and alertness.

   • Take note of appetite, sleep patterns, and pain levels.

3. Speak Up:

   • Report changes to the nurse or physician immediately.

   • Do not hesitate to escalate concerns if you feel they are not being taken seriously.

4. Document Everything:

   • Keep a log of vital signs and any concerning observations.

   • Take photos or videos if something seems wrong.

5. Use a Medical Advocate:

   • Consider hiring a patient advocate or care manager if the patient is high-risk.

6. Request the Rothman Index or Similar Tools:

   • Ask whether the facility uses predictive analytics.

   • Request access to trends or alerts if possible.

     
     

Helpful Resources for Safe Patient Monitoring

• Agency for Healthcare Research and Quality (AHRQ) – www.ahrq.gov

• The Joint Commission: Speak Up Campaign – www.jointcommission.org/speakup

• Patient Safety Movement Foundation – patientsafetymovement.org

• PeraTrend Rothman Index – www.peratrend.com

  
  

These resources provide guidelines, toolkits, and advocacy materials for improving monitoring in both inpatient and outpatient settings. All of these organizations are committed to improving patient safety as is EvaluCare.

How EvaluCare Can Help If You Suspect a Failure to Monitor

When a loved one suddenly deteriorates during a hospital stay, families often ask: "Was someone watching? Could this have been prevented?"

EvaluCare's expert team of nurses, physicians, and care reviewers analyze medical records to determine:

• Whether monitoring protocols were followed

• Whether early warning signs were documented and ignored

• Whether intervention was delayed or absent

  
  

We identify if negligence played a role in a patient’s outcome and offer clear, evidence-based insight. In many cases, EvaluCare can help families pursue direct settlements with healthcare facilities without immediately resorting to lengthy medical malpractice litigation.

A Compassionate Approach to Finding Answers

Healthcare should be a partnership between providers, patients, and families. When that partnership breaks down due to failure to monitor, the consequences can be devastating. But you're not alone.

At EvaluCare, we help families find answers, understand what went wrong, and hold providers accountable with compassion and clarity. Whether you're grieving a loss or managing the aftermath of a critical event, our team stands beside you.

You deserve to know what happened. EvaluCare can help uncover the truth and guide you toward the next steps in healing and resolution.

Learn more at www.EvaluCare.net or email info@EvaluCare.net

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References

1. AHRQ Patient Safety Network: Monitoring Failures and Adverse Events

   Explore resources and case studies related to monitoring failures and adverse events in healthcare.

   https://psnet.ahrq.gov/issue/monitoring-failures-and-adverse-events  

   
   

2. Patient Safety Movement Foundation: Preventable Deaths from Failure to Rescue

   Learn about initiatives aimed at reducing preventable deaths due to failure to rescue.

   https://patientsafetymovement.org/commitments/solutions/failure-to-rescue/

   
   

3. PeraTrend: Rothman Index Predictive Analytics

   Discover how PeraTrend utilizes the Rothman Index to predict patient declines for timely interventions.

   https://www.peratrend.com/rothman-index/

   
   

4. The Joint Commission Sentinel Event Alert: Vital Sign Monitoring

   Access alerts and guidelines on vital sign monitoring to prevent sentinel events.

   https://www.jointcommission.org/resources/sentinel-event/sentinel-event-alert-newsletters/

   
   

5. Malpractice Cases Database, 2018–2023

   Review a database of malpractice cases related to monitoring failures and other patient safety issues.

   https://www.medmaldb.com/cases/2018-2023

   
   

These resources provide valuable insights into patient safety practices, monitoring technologies, and legal considerations. If you need assistance interpreting any of this information or exploring how EvaluCare can support you in reviewing medical care for potential negligence, feel free to reach out.