Introduction: Lactic acid (LA) is a marker for shock and worsening outcomes in hospitalized patients. It has been associated with increased mortality at any level in patients with sepsis. After a patient safety event, our Failure to Rescue Team (FTR) began to track LA > 7 as a measure to identify potential correlations with out-of-ICU (OOICU) failure. Goal: To establish a rapid quality improvement (RQI) FTR multidisciplinary approach to enhance our high-reliability principles (HRO) and help reduce FTR. Our overarching goal was to lower codes outside the ICU (OOICU) and thereby increase RRT. Our team was working to determine a threshold for an automatic RRT or ICU upgrade trigger based on lactate trends. Methods: This is an RQI involving a multidisciplinary subteam from the FTR team at our institution. LA > 7 was trending from April 2025 through July 2025. The leads of the FTR team addressed these issues. Run charts and PDSA cycles were used to collect data and present findings to the team and organization. Results: On average, OOICU LA> 7 occurred 90% of the time in the ICUs. Seventy-four percent of LA values greater than 4 were in the ICU setting, with 22% in the progressive care areas. The causes were categorized into the top four groups, which accounted for 60% of the cases: trauma, hepatic failure, cardiogenic shock, and sepsis. Conclusions: Our team determined that a trigger based solely on LA was not suitable for our institution as an upgrade or RRT trigger. Developing a multidisciplinary approach to FTR reduction fostered a more collaborative relationship among all frontline staff, thereby enhancing HRO principles related to operational awareness and trust. The FTR team continues to monitor LA with detailed analyses; however, LA alone is not currently used as a trigger for patient upgrade.
Przybyl et al. (Sun,) studied this question.