Failure to Rescue as a Surgical Quality Indicator

  • Jorge I. Portuondo
    From the Michael E. DeBakey Department of Surgery (J.I.P., S.R.S., N.N.M.) and the Department of Medicine (H.S.), Baylor College of Medicine, Houston, Texas; the Division of Pediatric Surgery, Texas Children’s Hospital, Houston, Texas (S.R.S.); and the Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center (H.S., N.N.M.), Houston, Texas.
  • Sohail R. Shah
    From the Michael E. DeBakey Department of Surgery (J.I.P., S.R.S., N.N.M.) and the Department of Medicine (H.S.), Baylor College of Medicine, Houston, Texas; the Division of Pediatric Surgery, Texas Children’s Hospital, Houston, Texas (S.R.S.); and the Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center (H.S., N.N.M.), Houston, Texas.
  • Hardeep Singh
    From the Michael E. DeBakey Department of Surgery (J.I.P., S.R.S., N.N.M.) and the Department of Medicine (H.S.), Baylor College of Medicine, Houston, Texas; the Division of Pediatric Surgery, Texas Children’s Hospital, Houston, Texas (S.R.S.); and the Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center (H.S., N.N.M.), Houston, Texas.
  • Nader N. Massarweh
    From the Michael E. DeBakey Department of Surgery (J.I.P., S.R.S., N.N.M.) and the Department of Medicine (H.S.), Baylor College of Medicine, Houston, Texas; the Division of Pediatric Surgery, Texas Children’s Hospital, Houston, Texas (S.R.S.); and the Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center (H.S., N.N.M.), Houston, Texas.

抄録

<jats:title>Abstract</jats:title> <jats:p>Over the past decade, failure to rescue—defined as the death of a patient after one or more potentially treatable complications—has received increased attention as a surgical quality indicator. Failure to rescue is an appealing quality target because it implicitly accounts for the fact that postoperative complications may not always be preventable and is based on the premise that prompt recognition and treatment of complications is a critical, actionable point during a patient’s postoperative course. Although numerous patient and macrosystem factors have been associated with failure to rescue, there is an increasing appreciation of the key role of microsystem factors. Although failure to rescue is believed to contribute to observed hospital-level variation in both surgical outcomes and costs, further work is needed to delineate the underlying patient-level and system-level factors preventing the timely identification and treatment of postoperative complications. Therefore, the goals of this narrative review are to provide a conceptual framework for understanding failure to rescue, to discuss various associated patient- and system-level factors, to delineate the reasons it has become recognized as an important quality indicator, and to propose future directions of scientific inquiry for developing effective interventions that can be broadly implemented to improve postoperative outcomes across all hospitals.</jats:p>

収録刊行物

  • Anesthesiology

    Anesthesiology 131 (2), 426-437, 2019-08-01

    Ovid Technologies (Wolters Kluwer Health)

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