Failure To Rescue

Abstract

This paper discusses about the term Failure to rescue. FTR is the loss of life among hospitalized patients resulting from inadequate recognition and treatment of life-threatening complications. Silber and colleagues coined the phrase 'failure to rescue' (FTR) to describe patients who died from an acquired complication following surgery. The metric they described represents the proportion of deaths among patients who experience complications. It produces freely available indicators of hospital quality, termed patient safety indicators, that make use of inpatient hospital administrative data. Here, the term failure to rescue—surgical (FTR-S) is introduced as the proportion of patients with surgical complications who die during their index admission following an unplanned reoperation. Generally, failure to rescue has been defined as the death of a patient after a complication. The results indicated that adding one patient to a nurse's workload increased the odds of failure to rescue by 7% after controlling for patient and hospital characteristics.

Failure to Rescue

Introduction

Failure to rescue is the loss of life among hospitalized patients resulting from inadequate recognition and treatment of life-threatening complications. FTR is correlated with high ratios of patients to nurses and with psychological variables (e.g., burnout). It has been used, along with complication rates of surgery and other criteria, as an indicator of the quality of hospital care.

What does failure to rescue rates indicate?

Some deaths in hospital are inevitable. Much of the difference in death rates between hospitals has little to do with differences in the quality of care that people receive. Instead it is related to the degree of illness and co-morbidity of patients receiving treatment and how vulnerable they are. Measures like the Hospital Standardised Mortality Rate (HSMR) try to account for this using statistical techniques, but no statistical adjustment can ever be perfect. The rate of avoidable death among surgical patients with treatable complications (another way of referring to failure to rescue) gives another way of exploring how a hospital performs, one which relates to a specific group of (patients) and may offer some advantages.

For people undergoing surgery, the chance of developing a complication, like bleeding or pneumonia, is strongly related to factors such as their age or an underlying condition. But while complications are often a result of patient characteristics, the ability of a hospital to successfully treat a complication once it occurs is strongly related to the quality of care provided. The FTR indicator is intended to show how well hospitals perform once the complication occurs.

The potential significance of failure to rescue is reflected in recent reports and research which emphasise the complexity of response to deteriorating patients and highlight potential points of failure including:

not taking observations

not recording observations

not recognising early signs of deterioration

not communicating observations

For these reasons failure to rescue has often been considered particularly sensitive to the quality and quantity of nursing care that is available to patients.

How are “failure to rescue” rates measured?

Failure to rescue rates used for both research purposes and as quality indicators are typically derived from hospital administrative ...