Education  |   August 2019
Failure to Rescue as a Surgical Quality Indicator: Current Concepts and Future Directions for Improving Surgical Outcomes
Author Notes
  • 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.
  • This article is featured in “This Month in Anesthesiology,” page 1A.
    This article is featured in “This Month in Anesthesiology,” page 1A.×
  • Submitted for publication May 14, 2018. Accepted for publication November 29, 2018.
    Submitted for publication May 14, 2018. Accepted for publication November 29, 2018.×
  • Address correspondence to Dr. Massarweh: Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard (OCL 112), Houston, Texas, 77030. massarwe@bcm.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Education / Review Article / Quality Improvement
Education   |   August 2019
Failure to Rescue as a Surgical Quality Indicator: Current Concepts and Future Directions for Improving Surgical Outcomes
Anesthesiology 8 2019, Vol.131, 426-437. doi:10.1097/ALN.0000000000002602
Anesthesiology 8 2019, Vol.131, 426-437. doi:10.1097/ALN.0000000000002602
Abstract

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.