Abstract
BackgroundAllocation of limited resources to improve quality, patient safety, and outcomes is a decision-making challenge health care leaders face every day. While much valuable health care management research has concentrated on administrative data analysis, this approach often falls short of providing actionable information essential for effective management of specific system implementations and complex systems. This comprehensive performance analysis of a hospital-wide system illustrates application of various analysis approaches to support understanding specific system behaviors and identify leverage points for improvement. The study focuses on performance of a hospital rescue system supporting early recognition and response to patient deterioration, which is essential to reduce preventable inpatient deaths.MethodsRetrospective analysis of tertiary care hospital inpatient and rescue data was conducted using a systems analysis approach to characterize: patient demographics; rescue activation types and locations; temporal patterns of activation; and associations of patient factors, including complications, with post-rescue care disposition and outcomes.ResultsIncreases in bedside consultations (20% per year) were found with increased rescue activations during periods of resource limitations and changes (e.g., shift changes, weekends). Cardiac arrest, respiratory failure, and sepsis complications present the highest risk for rescue and death. Distributions of incidence of rescue and death by day of patient stay may suggest opportunities for earlier recognition.ConclusionsSpecific findings highlight the potential of using rescue-related risk and targeted resource deployment strategies to improve early detection of deterioration. The approach and methods applied can be used by other institutions to understand performance and allow rational incremental improvements to complex care delivery systems.
Highlights
Allocation of limited resources to improve quality, patient safety, and outcomes is a decision-making challenge health care leaders face every day
While multi-center studies relying on administrative data may provide epidemiological evidence of which hospital-level features are associated with failure to rescue (FTR), they provide little insight into how such systems can be effectively implemented
The analysis described here includes adult patients treated over a four-year interval and details associations of: demographics and characteristics of rescued patients; locations of care and complications present; rescue intervention types and utilization; temporal patterns of rescue activation; and rescue outcomes of death, survival, and care escalation
Summary
Allocation of limited resources to improve quality, patient safety, and outcomes is a decision-making challenge health care leaders face every day. While much valuable health care management research has concentrated on administrative data analysis, this approach often falls short of providing actionable information essential for effective management of specific system implementations and complex systems This comprehensive performance analysis of a hospital-wide system illustrates application of various analysis approaches to support understanding specific system behaviors and identify leverage points for improvement. Despite high adoption rates of tactics associated with FTR event reduction, a greater than two-fold variation in hospital mortality associated with serious but treatable events still exists [2], suggesting additional opportunity for improvement [15, 16] One contributor to this situation may be the paucity of hospital-specific system performance analysis of rescue care activity in available studies [1]. The adoption of high-level rescue care tactics without understanding institution-specific rescue system performance (e.g., by characterizing structure, process and outcome metrics) may explain the wide variation in intervention effectiveness and overall rescue outcomes reported [20]
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