A Review of Current and Emerging Approaches to Address Failure-to-Rescue

Abstract

Failure-to-Rescue, defined as hospital deaths after adverse events, is an established measure of patient safety and hospital quality. Until recently, approaches used to address failure-to-rescue have been focused primarily on improvement of response to a recognized patient crisis, with limited success in terms of patient outcomes. Less attention has been paid to improving the detection of the crisis. A wealth of retrospective data exist to support the observation that adverse events in general ward patients are preceded by a significant period (on the order of hours) of physiologic deterioration. Thus, the lack of early recognition of physiologic decline plays a major role in the failure-to-rescue problem.

In-hospital Mortality and Failure to Rescue After Cytoreductive Nephrectomy

“…Essentially, a hospital can have great surgeons with stateof-the-art technologies, but unless it can also provide effective management and timely recognition of outcomes, it can cause harm to patients. Following this concept, it has been hypothesized that while variation in adverse clinical outcomes may be due primarily to patient or disease characteristics at hospitalization, some hospitals may be less prepared to handle complications and rescue a patient after the occurrence of an adverse outcome, commonly referred to as the failure-to-rescue (FTR) concept [8][9][10][11][12].…”

An Analysis of Methodologies That Can Be Used to Validate if a Perioperative Surgical Home Improves the Patient-centeredness, Evidence-based Practice, Quality, Safety, and Value of Patient Care

“…FTR was first defined in 1992 by Silber et al 74 as hospital deaths after adverse events such as postsurgical complications. 75 In 2001, IOM identified FTR as one of the key areas for improvement in patient safety. 75,76 Contributors to FTR have been broadly categorized as the lack of a timely response (prompt recognition of the complication) and an appropriate response (correct management and treatment).…”

“…75 In 2001, IOM identified FTR as one of the key areas for improvement in patient safety. 75,76 Contributors to FTR have been broadly categorized as the lack of a timely response (prompt recognition of the complication) and an appropriate response (correct management and treatment). 72,73,75 In the above Medicare surgical cohort, overall FTR rates were higher (16.7 vs. 6.8%) at the worst compared with the best hospitals-but differed by as much as 4.0 versus 50.8% for major abdominal surgery.…”

“…73 The highly coordinated and integrated care provided by the PSH model should allow for a timelier and more appropriate response to patient physiologic derangement, thus reducing the FTR rate, major complications, and associated surgical morbidity and mortality. 72,73,75 Numerous healthcare quality and safety metrics have been put forth by various healthcare agencies, including (1) 82 The majority of the Centers for Medicare and Medicaid Services Appropriate Care Measures are not applicable to our proposed perioperative patient care model. The effect of Surgical Care Improvement Project adherence in lowering surgical site infection rates at the patient or hospital level has recently been challenged.…”

“…75,76 Contributors to FTR have been broadly categorized as the lack of a timely response (prompt recognition of the complication) and an appropriate response (correct management and treatment). 72,73,75 In the above Medicare surgical cohort, overall FTR rates were higher (16.7 vs. 6.8%) at the worst compared with the best hospitals-but differed by as much as 4.0 versus 50.8% for major abdominal surgery. 73 The highly coordinated and integrated care provided by the PSH model should allow for a timelier and more appropriate response to patient physiologic derangement, thus reducing the FTR rate, major complications, and associated surgical morbidity and mortality.…”