Failure to rescue in surgical patients: A review for acute care surgeons

Hatchimonji, Justin S.; Kaufman, Elinore J.; Sharoky, Catherine E.; Ma, Lucy; Whitlock, Anna E. Garcia; Holena, Daniel N.

doi:10.1097/ta.0000000000002365

Cited by 35 publications

(45 citation statements)

References 83 publications

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“…In relation to hospital setting, outcomes of mortality in patients who have developed complications, defined by Silber and colleagues in 1992 as failure to rescue (Silber et al., 1997), have increased from 27.1% in 2012 to 34.0% in 2017. Although our results are similar to those reported in the literature (Hatchimonji et al., 2019), the increasing trend must be taken into account because nursing factors such as staffing, education and work environment are the most demonstrated factor associated with failure to rescue (Hatchimonji et al., 2019; Kutney‐Lee et al., 2015; McHugh et al., 2013). With regard to mortality in low‐mortality DRGs, a safety indicator that reflects topics related to the care process due to identifies in‐hospital deaths in that group of patients who are unlikely to die during admission, the outcome in our study is low (0.06%) and has slightly decreased over the study period.…”

Section: Discussionsupporting

confidence: 88%

The experience of Catalonia measuring nurse‐sensitive indicators: Trends study 2012–2018

et al. 2021

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Aim To describe nursing‐sensitive indicators measured in Catalonia. Background In Catalonia, since 2012, under the umbrella of the Results Centre, outcomes of every health care setting have been published and made open to health care professionals and citizens. Methods Trends study of nursing‐sensitive indicators was based on data collected systematically from each setting from 2012 to 2018. Percentages and rates were calculated for each of 14 indicators analysed from all primary care, hospitals and long‐term care centres. Results Percentage of population aged 60 years or older correctly vaccinated against flu has been decreasing, while percentage of population aged 14 years or under with correct vaccine status is high (over 91%) and has remained stable over time. Mortality in patients who have developed complications has increased, from 27.1% in 2012 to 34.0% in 2017. Most centres achieved functional improvements during the first 30 days of admission. Conclusions Among all indicators measured in primary care, hospital and long‐term care, only 14 analysed are nursing‐sensitive; no nursing‐sensitive indicators regarding mental health are measured. Implications for Nursing Management Research focused on development of nursing‐sensitive indicators offers an opportunity to measure and benchmark nurses’ quality of care and their contribution in achieving populations’ health improvement and health care system sustainability.

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Section: Discussionsupporting

confidence: 88%

The experience of Catalonia measuring nurse‐sensitive indicators: Trends study 2012–2018

et al. 2021

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“…The correlation coefficient (r 2 ) between complication rate and in-hospital mortality was 0.2727 (P < 0.01) in all hospitals various complications after trauma in our study, with infections and coagulopathy being the most common, but these complications did not show clinical difference according to hospital performance of trauma care. Indeed, specific complications included in studies have varied over time [14]. Though we captured trivial complications compared to other previous FTR [14], selection of complications was similar to other FTR studies in trauma patients [11].…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, specific complications included in studies have varied over time [14]. Though we captured trivial complications compared to other previous FTR [14], selection of complications was similar to other FTR studies in trauma patients [11]. It is plausible that not only major complications, but also trivial complications, may be related to worse outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Though staffing and management data were not available for extraction in JTDB, these variables may have been related to reduction trauma surgery with a corresponding increase in endovascular treatment and intensive care. Others have reported that sophisticated technology and larger volumes of hospital and surgeons were modifiable hospital factors that improved FTR, although patient's factors were also related to FTR [14]. A team-based multidisciplinary approach could play an important role in trauma care by reducing judgment errors, delays in diagnosis of trauma, and crucial complications due to errors [17].…”

Section: Discussionmentioning

confidence: 99%

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Trauma complications and in-hospital mortality: failure-to-rescue

et al. 2020

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Background Reducing medical errors and minimizing complications have become the focus of quality improvement in medicine. Failure-to-rescue (FTR) is defined as death after a surgical complication, which is an institution-level surgical safety and quality metric that is an important variable affecting mortality rates in hospitals. This study aims to examine whether complication and FTR are different across low- and high-mortality hospitals for trauma care. Methods This was a retrospective cohort study performed at trauma care hospitals registered at Japan Trauma Data Bank (JTDB) from 2004 to 2017. Trauma patients aged ≥ 15 years with injury severity score (ISS) of ≥ 3 and those who survived for > 48 h after hospital admission were included. The hospitals in JTDB were categorized into three groups by standardized mortality rate. We compared trauma complications, FTR, and in-hospital mortality by a standardized mortality rate (divided by the institute-level quartile). Results Among 184,214 patients that were enrolled, the rate of any complication was 12.7%. The overall mortality rate was 3.7%, and the mortality rate among trauma patients without complications was only 2.8% (non-precedented deaths). However, the mortality rate among trauma patients with any complications was 10.2% (FTR). Hospitals were categorized into high- (40 facilities with 44,773 patients), average- (72 facilities with 102,368 patients), and low- (39 facilities with 37,073 patients) mortality hospitals, using the hospital ranking of a standardized mortality rate. High-mortality hospitals showed lower ISS than low-mortality hospitals [10 (IQR, 9–18) vs. 11 (IQR, 9–20), P < 0.01]. Patients in high-mortality hospitals showed more complications (14.2% vs. 11.2%, P < 0.01), in-hospital mortality (5.1% vs. 2.5%, P < 0.01), FTR (13.6% vs. 7.4%, P < 0.01), and non-precedented deaths (3.6% vs. 1.9%, P < 0.01) than those in low-mortality hospitals. Conclusions Unlike reports of elective surgery, complication rates and FTR are associated with in-hospital mortality rates at the center level in trauma care.

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“…The data set contains comprehensive preoperative, perioperative and postoperative demographic and outcome data of more than 100 000 patients who have undergone emergency laparotomy since December 2013. Despite several studies investigating FTR following elective abdominal surgery, there are currently few data evaluating the FTR metric in emergency surgery 13 . The present study used data from NELA for a secondary analysis to: describe rates of in-hospital mortality in patients undergoing emergency laparotomy for large bowel perforations in England; evaluate postoperative complications and FTR rates; and investigate whether FTR rates vary between hospitals.…”

Section: Introductionmentioning

confidence: 99%

Failure to rescue patients after emergency laparotomy for large bowel perforation: analysis of the National Emergency Laparotomy Audit (NELA)

et al. 2021

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Background Past studies have highlighted variation in in-hospital mortality rates among hospitals performing emergency laparotomy for large bowel perforation. The aim of this study was to investigate whether failure to rescue (FTR) contributes to this variability. Methods Patients aged 18 years or over requiring surgery for large bowel perforation between 2013 and 2016 were extracted from the National Emergency Laparotomy Audit (NELA) database. Information on complications were identified using linked Hospital Episode Statistics data and in-hospital deaths from the Office for National Statistics. The FTR rate was defined as the proportion of patients dying in hospital with a recorded complication, and was examined in hospitals grouped as having low, medium or high overall postoperative mortality. Results Overall, 6413 patients were included with 1029 (16.0 per cent) in-hospital deaths. Some 3533 patients (55.1 per cent) had at least one complication: 1023 surgical (16.0 per cent) and 3332 medical (52.0 per cent) complications. There were 22 in-hospital deaths following a surgical complication alone, 685 deaths following a medical complication alone, 150 deaths following both a surgical and medical complication, and 172 deaths with no recorded complication. The risk of in-hospital death was high among patients who suffered either type of complication (857 deaths in 3533 patients; FTR rate 24.3 per cent): 172 deaths followed a surgical complication (FTR-surgical rate 16.8 per cent) and 835 deaths followed a medical complication (FTR-medical rate of 25.1 per cent). After adjustment for patient characteristics and hospital factors, hospitals grouped as having low, medium or high overall postoperative mortality did not have different FTR rates (P = 0.770). Conclusion Among patients having emergency laparotomy for large bowel perforation, efforts to reduce the risk of in-hospital death should focus on reducing avoidable complications. There was no evidence of variation in FTR rates across National Health Service hospitals in England.

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Failure to rescue in surgical patients: A review for acute care surgeons

Cited by 35 publications

References 83 publications

The experience of Catalonia measuring nurse‐sensitive indicators: Trends study 2012–2018

The experience of Catalonia measuring nurse‐sensitive indicators: Trends study 2012–2018

Trauma complications and in-hospital mortality: failure-to-rescue

Failure to rescue patients after emergency laparotomy for large bowel perforation: analysis of the National Emergency Laparotomy Audit (NELA)

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