Faculty Collaboration Database

Failure-to-rescue after injury is associated with preventability: The results of mortality panel review of failure-to-rescue cases in trauma. Surgery 2017 Mar;161(3):782-790

Date

10/30/2016

Pubmed ID

27788924

Pubmed Central ID

PMC5803187

DOI

10.1016/j.surg.2016.08.017

Scopus ID

2-s2.0-85006026341 (requires institutional sign-in at Scopus site)   28 Citations

Abstract

BACKGROUND: Failure-to-rescue is defined as the conditional probability of death after a complication, and the failure-to-rescue rate reflects a center's ability to successfully "rescue" patients after complications. The validity of the failure-to-rescue rate as a quality measure is dependent on the preventability of death and the appropriateness of this measure for use in the trauma population is untested. We sought to evaluate the relationship between preventability and failure-to-rescue in trauma.

METHODS: All adjudications from a mortality review panel at an academic level I trauma center from 2005-2015 were merged with registry data for the same time period. The preventability of each death was determined by panel consensus as part of peer review. Failure-to-rescue deaths were defined as those occurring after any registry-defined complication. Univariate and multivariate logistic regression models between failure-to-rescue status and preventability were constructed and time to death was examined using survival time analyses.

RESULTS: Of 26,557 patients, 2,735 (10.5%) had a complication, of whom 359 died for a failure-to-rescue rate of 13.2%. Of failure-to-rescue deaths, 272 (75.6%) were judged to be non-preventable, 65 (18.1%) were judged potentially preventable, and 22 (6.1%) were judged to be preventable by peer review. After adjusting for other patient factors, there remained a strong association between failure-to-rescue status and potentially preventable (odds ratio 2.32, 95% confidence interval, 1.47-3.66) and preventable (odds ratio 14.84, 95% confidence interval, 3.30-66.71) judgment.

CONCLUSION: Despite a strong association between failure-to-rescue status and preventability adjudication, only a minority of deaths meeting the definition of failure to rescue were judged to be preventable or potentially preventable. Revision of the failure-to-rescue metric before use in trauma care benchmarking is warranted.

Author List

Kuo LE, Kaufman E, Hoffman RL, Pascual JL, Martin ND, Kelz RR, Holena DN

Author

Daniel N. Holena MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Failure to Rescue, Health Care
Female
Hospital Mortality
Humans
Male
Middle Aged
Retrospective Studies
Survival Analysis
Wounds and Injuries
Young Adult