Abstract
Introduction: Failure to Rescue (FTR) is the failure to prevent a patient’s death after a complication. It measures the ability of a hospital to prevent the death of patients who develop one or more complication that was not present at the time of admission. Therefore, the aim of this study is to review the factors that contribute to FTR, and the measures and strategies that can be applied to prevent the FTR events, in order to discuss the best way to improve patient outcomes in the hospital setting. Methods: A search was conducted on PUBMED retrieving a total of 464 articles. A review of the selected articles’ bibliography was conducted to find other relevant articles. Sixty studies were reviewed in this paper. Results: Patient factors as increasing age, comorbidities and frailty increase the risk of FTR, as well as an increasing number of complications. Several hospital factors, nursing care, and microsystem also influence FTR. Some track and Trigger Systems (TTS) and Early Warning Scores (EWS) have been shown to predict clinical deterioration. On the other hand, machine learning systems have outperformed EWS. Rapid response teams have become the standard approach to delivery and escalation of care, and cognitive aids and crisis checklists also have potential to help reduce FTR. Conclusion: Patient and hospital factors are often non-modifiable; thus, microsystem factors could be a target for improvement. Creating clinical pathways can improve surveillance, and communication tools like SBAR can help relay information. EWS, machine learning models and continuous monitoring are strategies that can help detect clinical deterioration. In the efferent limb rapid response teams have shown to reduce FTR.
Highlights
Failure to Rescue (FTR) is the failure to prevent a patient’s death after a complication
Having various versions of this metric, created for different subpopulations, it can alter the calculation of the FTR based on which definition is used, can be helpful to evaluate the occurrence of this event in different settings, with different particularities, more accurately [8]
A search was conducted on PUBMED using the following keyword combinations: "failure to rescue health care statistics and numerical data"; "failure to rescue quality"; "failure to rescue rates"; "failure to rescue health care"; "failure to rescue" AND rapid response system; "medical care" AND "failure to rescue"; "failure to rescue" AND deteriorating patient; "failure to rescue" AND general ward; rapid response team AND "failure to rescue"; hospital staffing AND "failure to rescue"; early warning score* AND "failure to rescue"; medical emergency team* AND "failure to rescue"; track and trigger AND "failure to rescue"; "failure to rescue" AND continuous monitoring; "failure to rescue" AND telemedicine; concept OR definition AND "failure to rescue"
Summary
Failure to Rescue (FTR) is the failure to prevent a patient’s death after a complication It measures the ability of a hospital to prevent the death of patients who develop one or more complication that was not present at the time of admission. Failure to Rescue (FTR) was first described in 1992 by Silber et al as the failure to prevent death after a complication in the surgical patients. According to Silber et al, there were only 2 formal attempts to develop a medical FTR metric before their own in 2018 [1,2,3,4] It measures the ability of a hospital to prevent the death of patients who develop one or more complication that was not present at the time of admission by identifying and successfully managing it [4,5,6]. Even so, having a common definition would serve to use and measure it as a common metric for all hospitals [1]
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