Original article
Adult cardiac
Failure-to-Rescue Rate as a Measure of Quality of Care in a Cardiac Surgery Recovery Unit: A Five-Year Study

https://doi.org/10.1016/j.athoracsur.2013.07.097Get rights and content

Background

Failure to rescue, which is defined as the probability of death after a complication that was not present on admission, was introduced as a quality measure in the 1990s, to complement mortality and morbidity outcomes. The objective of this study was to evaluate possible incremental benefits of measuring failure to rescue after cardiac surgery, to facilitate quality improvement efforts.

Methods

Data were collected prospectively on 4,978 consecutive patients who underwent cardiac operations during a 5-year period. Institutional logistic regression models were used to generate predicted rates of mortality and major complications. Frequency distributions of morbidities were determined, and failure to rescue was calculated. The annual failure-to-rescue rates were contrasted using χ2 tests and compared with morbidity and mortality measures.

Results

The overall mortality rate was 3.6%, the total complication rate was 16.8%, and the failure-to-rescue rate was 19.8% (95% confidence interval, 17.1% to 22.7%). The predicted risk of mortality and of major complications increased during the last 2 years of the study, whereas the observed complication rate decreased. Failure to rescue for new renal failure was the highest of all complications (48.4%), followed by septicemia (42.6%). Despite the decreased complication rate toward the end of the study, the failure-to-rescue rate did not change significantly (p = 0.28).

Conclusions

Failure to rescue should be monitored as a quality-of-care metric, in addition to mortality and complication rates. Postoperative renal failure and septicemia still have a high failure-to-rescue rate and should be targeted by quality improvement efforts.

Section snippets

Patients and Methods

Study approval and a waiver of the need for individual patient consent was granted by the Research Ethics Board of Western University.

Our cardiac surgery recovery unit was physically consolidated as a dedicated, 16-bed unit in April 2005 [14]. It is staffed by a consultant group that includes cardiac surgeons, cardiac anesthesiologists, and critical care physicians. In-house night call is provided by midlevel or senior postgraduate trainees in cardiac anesthesiology, critical care, and cardiac

Results

Data on 4,978 consecutive patients were analyzed. The overall mortality, complication, and FTR rates were 180 (3.6%), 834 (16.8%), and 165 of 834 (19.8%), respectively. The baseline characteristics of the 834 patients with postoperative complications who were included in our FTR analyses are displayed in Table 1. Table 2 shows the overall FTR rates for the ten major complications. New renal failure requiring dialysis and septicemia were associated with the highest FTR rates, which were both

Comment

This study analyzed the FTR during a 5-year period in a dedicated cardiac surgery recovery unit. Our principal motivation was to evaluate the performance of our unit and to use the FTR rate as a guide for future quality improvement efforts. We also wished to explore the incremental value of FTR as a quality assurance measure. The overall FTR did not change significantly during the 5-year study period (p = 0.279), with an average rate of 19.8% (95% confidence interval, 17.1% to 22.7%). Our data

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