Failure to rescue and 30‐day in‐hospital mortality in hospitals with and without crew‐resource‐management safety training

Abstract

Failure to rescue (FTR) occurs when a clinician is unable to save a hospitalized patient's life when they experience a complication that was not present on admission. Research suggests that a focus on patient safety, including implementing airline‐industry‐based‐crew‐resource management (CRM) training, can improve patient outcomes, however, the effects of CRM on FTR are unknown. This study examined FTR and 30‐day in‐hospital mortality (IM) outcomes in two hospitals to determine if differences existed in the treatment hospital (received CRM training) and the comparison hospital (did not receive CRM training). Researchers expected there would be lower rates of FTR and IM in the treatment hospital than the comparison hospital. The study utilized a matched two‐group comparison, cross‐sectional quasi‐experimental design. Over 10,000 patients (n = 10,823) comprised the study with 1,764 having at least one FTR complication. Adjusted odds of FTR were 2.9% higher for treatment versus comparison but these results did not reach significance. The adjusted odds of IM were 0.4% higher for treatment versus comparison but not significantly higher. Although the reasons for our findings remain unclear, previous researchers also found that CRM training improved staff outcomes but unexpectedly did not improve patient outcomes. CRM training may best be used to target changes in staff behaviors and improvement in staff outcomes. Refresher CRM training may be needed to prevent drifting back into longstanding behaviors. Reductions in FTR and patients with IM outcomes may require more comprehensive, multipronged interventions in addition to CRM training.

Medical and Legal Implications of Failure to Rescue

“…The ultimate success of CRM training in medicine is quite variable and complex. Bacon et al [2] postulated that a strong organization safety culture complimented by comprehensive CRM training would improve failure to rescue and reduce inhospital mortality. They found that the reduction in failure to rescue and in-hospital mortality was not realized after implementation of CRM, but the study did not include refresher CRM training.…”

Organizational Safety Climate and Job Enjoyment in Hospital Surgical Teams With and Without Crew Resource Management Training

“…This study is part of a larger study that investigated the relationship between OSC and patient deaths in hospitals. 11,13 We made several important theoretical assumptions that underpin the current study. Our model, depicted in Figure 1, maintains that a comprehensive hospital safety culture must include 7 foundational components, which are applied and reinforced through 7 components of CRM training and, in turn, are expected to positively influence employee OSC and JE scores.…”

“…This study is part of a larger study that investigated the relationship between OSC and patient deaths in hospitals 11,13 . We made several important theoretical assumptions that underpin the current study.…”

Perceptions of Responsibilities by Primary Care Staff in a Patient-Centered Medical Home

“…11 SMM allows team members to understand what tasks require and anticipate actions of other team members relative to that task. 11 The concept of SMM started in aviation and was then adopted in healthcare where early studies of SMM in healthcare focused on the use of crew resource management 12,13 and TEAMStepps (Team Strategies and Tools to Enhance Performance and Patient Safety). 14 Additional support for the importance of SMM is the development of role clarity among nurses; others' perceptions interact with nurses' selfperceptions to ultimately influence nurse professional role clarity.…”