Impact of Hospital Characteristics on Failure to Rescue Following Major Surgery

Abstract

Objective To determine the effect of hospital characteristics on failure to rescue after high-risk surgery in Medicare Beneficiaries. Summary Background Data Reducing failure to rescue events is a common quality target for U.S. hospitals. Little is known about which hospital characteristics influence this phenomenon and more importantly by how much. Methods We identified 1,945,802 Medicare beneficiaries undergoing one of six high-risk general or vascular operations between 2007-10. Using multilevel mixed-effects logistic regression modeling, we evaluated how failure to rescue rates were influenced by specific hospital characteristics previously associated with postsurgical outcomes. We used variance partitioning to determine the relative influence of patient and hospital characteristics on the between-hospital variability in failure to rescue rates. Results Failure to rescue rates varied up to 11-fold between very high and very low mortality hospitals. Comparing the highest and lowest mortality hospitals, we observed that teaching status (range: OR 1.08-1.54), high hospital technology (range: OR 1.08-1.58), increasing nurse-to-patient ratio (range: OR 1.02-1.14), and presence of >20 ICU beds (range: OR 1.09-1.62) significantly influenced failure to rescue rates for all procedures. When taken together, hospital and patient characteristics accounted for 12% (lower extremity revascularization) to 57% (esophagectomy) of the observed variation in failure to rescue rates across hospitals. Conclusions While several hospital characteristics are associated with lower failure to rescue rates, these macro-system factors explain a small proportion of the variability between hospitals. This suggests that micro-system characteristics, such as hospital culture and safety climate, may play a larger role in improving a hospital's ability to manage postoperative complications.

Nationwide in-hospital mortality rate following rectal resection for rectal cancer according to annual hospital volume in Germany

“…Data from the American College of Surgeons National Surgical Quality Improvement Program 28 and Medicare 29 on postoperative mortality rates have shown that failure to rescue, rather than overall mortality, is strongly dependent on hospital volume. A subsequent analysis 30 found that it was mainly hospital status (academic versus non-academic), ICU capacity and academic character that determined the failure-to-rescue rate. A study 31 focusing on failure to rescue after colorectal resection in the Netherlands demonstrated that low-level ICU care in particular was associated with increased failure-to-rescue rates.…”

Impact of the insurance type of head and neck cancer patients on their hospitalization utilization patterns

“…According to previous studies and the literature, the reasons for suboptimal outcomes in certain hospital settings are likely to be multifactorial and include differences in staffing levels and skills [27][28][29][30][31] ; in resources, services, infrastructure, technologies, and available equipment 23,[30][31][32] ; in experience driven by the patient volume 30,33 ; in compliance with treatment guidelines 34 ; and in postoperative complication management. 23,32 In contrast to our findings of significant differences between urban teaching, nonteaching, and rural hospitals by insurance status, Bhattacharyya et al 31 analyzed data from the NIS and did not find any significant difference in the distribution of HNC patients by insurance status (payer mix) in teaching hospitals versus nonteaching hospitals in 2010. These differences might be the result of the different categorization of a hospital's teaching status in this study.…”

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

“…Suggested strategies are demanding: understanding of the single hospital system, caregivers, available resources; implementing process methods to effectively learn from failure to rescue events; improving hospital safety culture (30,44).…”