Failure-to-rescue after injury is associated with preventability: The results of mortality panel review of failure-to-rescue cases in trauma

Abstract

Background Failure-to-rescue is defined as the conditional probability of death after a complication, and the failure-to-rescue rate reflects a center’s ability to successfully “rescue” patients after complications. The validity of the failure-to-rescue rate as a quality measure is dependent on the preventability of death and the appropriateness of this measure for use in the trauma population is untested. We sought to evaluate the relationship between preventability and failure-to-rescue in trauma. Methods All adjudications from a mortality review panel at an academic level I trauma center from 2005–2015 were merged with registry data for the same time period. The preventability of each death was determined by panel consensus as part of peer review. Failure-to-rescue deaths were defined as those occurring after any registry-defined complication. Univariate and multivariate logistic regression models between failure-to-rescue status and preventability were constructed and time to death was examined using survival time analyses. Results Of 26,557 patients, 2,735 (10.5%) had a complication, of whom 359 died for a failure-to-rescue rate of 13.2%. Of failure-to-rescue deaths, 272 (75.6%) were judged to be non-preventable, 65 (18.1%) were judged potentially preventable, and 22 (6.1%) were judged to be preventable by peer review. After adjusting for other patient factors, there remained a strong association between failure-to-rescue status and potentially preventable (odds ratio 2.32, 95% confidence interval, 1.47–3.66) and preventable (odds ratio 14.84, 95% confidence interval, 3.30–66.71) judgment. Conclusion Despite a strong association between failure-to-rescue status and preventability adjudication, only a minority of deaths meeting the definition of failure to rescue were judged to be preventable or potentially preventable. Revision of the failure-to-rescue metric before use in trauma care benchmarking is warranted.

Failure to Rescue, Rescue Surgery and Centralization of Postoperative Complications: A Challenge for General and Acute Care Surgeons

“…After an initial interest in the application of this concept in trauma setting (32,33), some concerns about the potential use of FTR as a quality benchmark in trauma were raised (9,8). The reason is the fact preventable death is a long lasting issue in trauma care quality assessment, and the effectiveness of trauma systems are usually measured on the decreasing rate of preventable deaths.…”

Number and Type of Complications Associated With Failure to Rescue in Trauma Patients

“…24 FTR combines the strengths of measuring mortality and complication rates and may be of particular relevance in the trauma population. 25 FTR is increasingly used as a hospital quality metric reflecting the performance of hospitals when addressing postoperative complications. 26 This makes it an important benchmark for patient safety.…”

Failure to Rescue – a Closer Look at Mortality Rates Has No Added Value for Hospital Comparisons but Is Useful for Team Quality Assessment in Abdominal Aortic Aneurysm Surgery in The Netherlands

“…18 However, death may be an unwanted outcome but cannot always be prevented, which can be the case in emergency surgery, such as RAAA patients. 19,20 Another difficulty is that the definition used for FTR varies in the types of complications that are included in the denominator or whether or not to exclude those patients that die without a complication. 19 The authors support the view of the developers of FTR, that death is considered as a result of a complication and therefore all deaths should be included in FTR, in the numerator and in the denominator.…”

“…19,20 Another difficulty is that the definition used for FTR varies in the types of complications that are included in the denominator or whether or not to exclude those patients that die without a complication. 19 The authors support the view of the developers of FTR, that death is considered as a result of a complication and therefore all deaths should be included in FTR, in the numerator and in the denominator. 11 Although alternatives have been proposed, the inclusion of mortality in the Figure 4.…”