Abstract
BackgroundDespite the increased acceptance of failure-to-rescue (FTR) as an important patient safety indicator (defined as the percentage of deaths among surgical patients with treatable complications), there has not been any large epidemiological study reporting FTR in an Australian setting nor any evaluation on its suitability as a performance indicator.MethodsWe conducted a population-based study on elective surgical patients from 82 public acute hospitals in New South Wales, Australia between 2002 and 2009, exploring the trends and variations in rates of hospital complications, FTR and 30-day mortality. We used Poisson regression models to derive relative risk ratios (RRs) after adjusting for a range of patient and hospital characteristics.ResultsThe average rates of complications, FTR and 30-day mortality were 13.8 per 1000 admissions, 14.1% and 6.1 per 1000 admission, respectively. The rates of complications and 30-day mortality were stable throughout the study period however there was a significant decrease in FTR rate after 2006, coinciding with the establishment of national and state-level peak patient safety agencies. There were marked variations in the three rates within the top 20% of hospitals (best) and bottom 20% of hospitals (worst) for each of the four peer-hospital groups. The group comprising the largest volume hospitals (principal referral/teaching hospitals) had a significantly higher rate of FTR in comparison to the other three groups of smaller-sized peer hospital groups (RR = 0.78, 0.57, and 0.61, respectively). Adjusted rates of complications, FTR and 30-day mortality varied widely for individual surgical procedures between the best and worst quintile hospitals within the principal referral hospital group.ConclusionsThe decrease in FTR rate over the study period appears to be associated with a wide range of patient safety programs. The marked variations in the three rates between- and within- peer hospital groups highlight the potential for further quality improvement intervention opportunities.
Highlights
The concept of failure-to-rescue (FTR) was first coined by Silber and colleagues in 1992 [1] with the intention of measuring potentially preventable deaths after surgical complications
While the original concept of FTR covered a wide range of surgical complications, the AHRQ definition focused on surgical patients who developed at least one of six complications during hospitalisation as one of its patient safety indicator (PSI): acute renal failure, deep vein thrombosis, pneumonia, sepsis, shock, and gastrointestinal bleeding [3]
We examined variations in all three outcomes for the six groups of surgical procedures within the principal referral group because most of the major surgical procedures were performed in teaching hospitals
Summary
The concept of failure-to-rescue (FTR) was first coined by Silber and colleagues in 1992 [1] with the intention of measuring potentially preventable deaths after surgical complications. Given the growing recognition of rapid response systems (RRS) for the timely identification and response to in-hospital deteriorating patients, the term of FTR is used for evaluating the effectiveness of RRSs [4,5]. In this context, the measure of FTR can estimate the entire organization’s ability to prevent avoidable complications such as unexpected cardiac arrest and related deaths for all hospital patients, not just surgical patients [3,6,7,8]. Despite the increased acceptance of failure-to-rescue (FTR) as an important patient safety indicator (defined as the percentage of deaths among surgical patients with treatable complications), there has not been any large epidemiological study reporting FTR in an Australian setting nor any evaluation on its suitability as a performance indicator
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