Failure to rescue (FTR)

Failure to rescue (FTR) is a medical term used for a death that occurs after a patient has a complication while under medical care. These are generally considered avoidable deaths, though there are some factors outside of a medical professional's control that can contribute to a death from a complication. In the twenty-first century, FTR statistics have been identified as a key way to measure the effectiveness of a hospital, medical team, or factor in the health care process.

Background

In 1992, Jeffrey H. Silber created the FTR concept as a method of measuring the effectiveness of medical care. Silber, a physician and medical researcher, is considered an authority on the factors that influence patient outcomes during and after medical care. The FTR criteria he developed was used by the US National Quality Forum (NQF) to establish three measures of the quality of care provided to patients. Since then, decades of use have confirmed the effectiveness of Silber's methodology.

Silber's work built on the work of others, including professionals inside and outside the medical field. Beginning in the 1980s, anesthesiologists identified the ways that small errors in the administration of anesthesia could affect a patient's health. They began efforts to catch and correct these errors quickly before they had a chance to become serious. As new procedures, drugs, and technologies continue to come into use, the process of identifying and correcting complications continues.

All of these FTR-related efforts acknowledge that not all complications are preventable and that unknowns in medicine are inevitable. However, problems and complications that do arise should be recognized and addressed quickly. More than two decades after Silber introduced the concept, medical clinicians continue to refine his methods. This includes identifying some of the most common types of complications that can affect a patient's health, developing protocols for avoiding and correcting complications, and finding ways to use statistics related to FTR to evaluate the effectiveness of a medical facility and/or its staff.

Overview

Measuring the effectiveness of a hospital or other aspect of the health care system can be complicated because there are many variables. For example, analyzing the number of deaths that occur may not be a fair way to compare two facilities because one may specialize in treating trauma patients with more serious conditions while another focuses on providing care to patients with a lower likelihood of death, such as maternity patients. Such comparisons also cannot account for things like the patient's overall health and other conditions that can affect lifespan, such as diabetes, heart disease, and obesity.

Instead of measuring factors over which medical personnel have little control, such as the condition in which their patients arrive, FTR focuses on an aspect of care that is almost completely within the control of the medical staff—how well they recognize and address emergent health conditions. For example, if a patient has surgery and later develops a fever, it is likely an infection has developed. The physicians and nurses may not have been able to prevent the need for the surgery or even the infection that developed, but they can recognize that the patient has a fever and that this is a sign of a complication. They can then take appropriate steps to address the complication. Should they fail to do so, this would be an instance of FTR.

There are countless potential causes for FTR. However, medical professionals have identified some as the most common complications that can lead to death if not recognized and corrected in a timely manner. These complications include but are not limited to the following issues:

heart-related problems such as abnormal heartbeats

lung-related issues such as pneumonia or bronchial spasms

low blood pressure that results in shock

brain-related issues such as strokes and seizures

problems in the blood stream such as clots or embolisms

infections including gangrene

undetected internal bleeding

obstructions of the intestines

diseases affecting the internal organs, such as hepatitis or pancreatitis

Medical professionals have also identified some of the key reasons these complications may go undetected. These can usually be classified as problems that are not noticed, are not recognized, are not responded to, or are not reported to those who could attend to them. In addition to potential problems related to the patient's main health issue, such as being unconscious and unable to notify the care team of new symptoms, other causes can contribute to an FTR situation. These include communication problems among the staff, inexperienced staff members, and lax procedures for monitoring patients and recording observations. Sometimes, these can be attributed further to overworked staff or insufficient staff to attend to all patient needs effectively.

Some of the methods to correct or avoid FTR situations include the following:

establishing specific protocols for observing and recording patient information

increasing training in early identification of complications and procedures for responding to them

decreasing the responsibilities of the nursing staff, who are generally the first to recognize and initiate a response to patient complications

ensuring adequate staffing for clinical areas

Staff should also be aware of when a complication requires escalation and feel empowered to tale action. The addition of technology, such as electronic patient records in place of notes on paper charts, can also help prevent complications.

Analysis of FTR rates has become an effective tool in identifying ways to rate medical professionals and facilities and improve them. Thorough analysis helps to recognize the most common types of problems in a given facility. It also helps to determine the effectiveness of various methods to identify and correct complications and minimize the number of complications that require escalation.

Bibliography

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"Failure to Rescue." Med League, www.medleague.com/failure-to-rescue‗prevention/. Accessed 17 Nov. 2017.

"Failure to Rescue." US Department of Health and Human Services Patient Safety Network, Nov. 2017, psnet.ahrq.gov/primers/primer/38/failure-to-rescue. Accessed 17 Nov. 2017.

Hravnak, Marilyn. "Causes of Failure to Rescue: Implications for Rapid Response Systems." University of Pittsburg, cme.baptisthealth.net/sossymposium/documents/presentations/2015/hravnak‗implications‗rapid‗response.pdf. Accessed 17 Nov. 2017.

"Jeffrey H. Silber, MD, PhD." Children's Hospital of Philadelphia, cor.research.chop.edu/jeffrey‗silber. Accessed 17 Nov. 2017.

Kremsdorf, Richard. "Failure to Rescue and Errors of Omission." Patient Safety and Quality Health Care, July–Aug. 2005, www.psqh.com/julaug05/ails.html. Accessed 17 Nov. 2017.

Kremsdorf, Richard. "Tackling the Underlying Problems of Failure to Rescue." The Hospitalist, Mar. 2005, www.the-hospitalist.org/hospitalist/article/122945/tackling-underlying-problems-failure-rescue. Accessed 17 Nov. 2017.

Xu, Hattie. "Research Examines Causes of Failure to Rescue." Brown Daily Herald, 27 Oct. 2015, www.browndailyherald.com/2015/10/27/research-examines-causes-of-failure-to-rescue/. Accessed 17 Nov. 2017.