Failure to Rescue: A Quality Metric for Cardiac Surgery and Cardiovascular Critical Care
Caroline R Gross, David H Adams, Parth Patel, Robin Varghese
Abstract:
Failure to rescue, defined as mortality following a surgical complication, is a widely accepted quality metric across many specialties and is becoming an important metric in cardiac surgery. The failure to rescue metric provides a target for improvements in patient outcomes after complications occur. To be used appropriately, the failure to rescue metric must be defined using a pre-specified set of life-threatening and rescuable complications. Successful patient rescue requires a systematic approach of complication recognition, timely escalation of care, effective medical management, and mitigation of additional complications. This process requires contributions from cardiac surgeons, intensivists, and other specialists including cardiologists, neurologists, and anesthesiologists. Factors affecting failure to rescue rates in cardiac surgery and cardiovascular critical care include nurse staffing ratios, intensivist coverage, advanced specialist support, hospital and surgical volume, the presence of trainees, and patient comorbidities. Strategies to improve patient rescue include working to understand the mechanisms of failure to rescue, anticipating postoperative complications, prioritizing microsystem factors, enhancing early escalation of care, and educating and empowering junior clinicians. When used appropriately, the failure to rescue quality metric can help institutions focus on improving processes of care that minimize morbidity and mortality from rescuable complications following cardiac surgery.
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Publications
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Transcatheter Repair for Patients with Tricuspid Regurgitation
Paul Sorajja, MD, Brian Whisenant, MD, David H. Adams, MD, et al. -
Failure to Rescue: A Quality Metric for Cardiac Surgery and Cardiovascular Critical Care
Caroline R Gross, David H Adams, Parth Patel, Robin Varghese -
Research Opportunities in the Treatment of Mitral Valve Prolapse: JACC Expert Panel
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Plasma Renin Activity Increases With Cardiopulmonary Bypass and is Associated With Vasoplegia After Cardiac Surgery
Morgan L Montgomery, Caroline R Gross, Hung-Mo Lin, Yuxia Ouyang, Matthew A Levin, Holly E Corkill, Ahmed El-Eshmawi, David H Adams, Menachem M Weiner