Impact of Hospital Characteristics on Failure to Rescue Following Major Surgery. Ann Surg 2016 Apr;263(4):692-7
Date
10/27/2015Pubmed ID
26501706Pubmed Central ID
PMC4777662DOI
10.1097/SLA.0000000000001414Scopus ID
2-s2.0-84945290318 (requires institutional sign-in at Scopus site) 153 CitationsAbstract
OBJECTIVE: To determine the effect of hospital characteristics on failure to rescue after high-risk surgery in Medicare beneficiaries.
SUMMARY BACKGROUND DATA: Reducing failure to rescue events is a common quality target for US hospitals. Little is known about which hospital characteristics influence this phenomenon and more importantly by how much.
METHODS: We identified 1,945,802 Medicare beneficiaries undergoing 1 of six high-risk general or vascular operations between 2007 and 2010. Using multilevel mixed-effects logistic regression modeling, we evaluated how failure to rescue rates were influenced by specific hospital characteristics previously associated with postsurgical outcomes. We used variance partitioning to determine the relative influence of patient and hospital characteristics on the between-hospital variability in failure to rescue rates.
RESULTS: Failure to rescue rates varied up to 11-fold between very high and very low mortality hospitals. Comparing the highest and lowest mortality hospitals, we observed that teaching status (range: odds ratio [OR] 1.08-1.54), high hospital technology (range: OR 1.08-1.58), increasing nurse-to-patient ratio (range: OR 1.02-1.14), and presence of >20 intensive care unit (ICU) beds (range: OR 1.09-1.62) significantly influenced failure to rescue rates for all procedures. When taken together, hospital and patient characteristics accounted for 12% (lower extremity revascularization) to 57% (esophagectomy) of the observed variation in failure to rescue rates across hospitals.
CONCLUSIONS: Although several hospital characteristics are associated with lower failure to rescue rates, these macrosystem factors explain a small proportion of the variability between hospitals. This suggests that microsystem characteristics, such as hospital culture and safety climate, may play a larger role in improving a hospital's ability to manage postoperative complications.
Author List
Sheetz KH, Dimick JB, Ghaferi AAAuthor
Amir Ghaferi MD President, Phys Enterprise & SAD Clinical Affairs in the Medical College Physicians Administration department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AgedAged, 80 and over
Digestive System Surgical Procedures
Female
Healthcare Disparities
Hospital Mortality
Hospitals
Humans
Logistic Models
Male
Medicare
Postoperative Complications
Treatment Failure
United States
Vascular Surgical Procedures
