Introduction
This essay will critically evaluate ‘failure to rescue’ as it relates to the deteriorating patient in the acute healthcare environment. The essay will discuss the incidence of adverse events linked to failure to rescue in the Australian acute healthcare environment, and evaluate the consequences of failure to rescue for different stakeholders. The essay will then evaluate two nursing strategies, rapid response systems and systematic staffing reviews, that have the potential to prevent registered nurses from failing to rescue the patient and maintain patient safety.
The concept of ‘failure of rescue’
‘Failure to rescue’, in an acute healthcare environment, refers to the inability of healthcare providers to prevent a clinically critical deterioration, such as death or disability, in patients with complications from surgery, medical care or underlying illness, or healthy patients who developed complications. For example, a patient with underlying hypertension and chronic kidney disease may be admitted for elective dilatation and curettage for postmenopausal bleeding, and reported slight abdominal pain, elevated creatinine levels and an elevated breathing rate. The patient later suffered atrial fibrillation, abdominal pain, and deteriorated into a state of serious hematemesis, eventually dying of gastrointestinal bleeding. This represents a failure to rescue.
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‘Failure to rescue’ has been used as a quality service metric to evaluate the standards of a hospital’s healthcare provision, and is typically defined as the total number of deaths resulting from a complication from a medical procedure, although more restricted definitions such as FTR-N and FTR-A have been used with lower reliability and validity. (Silber et al, 2007)
‘Failure to rescue’ is often linked to both patient factors, such as age and comorbidities, as well as healthcare and hospital factors such as negligence in monitoring of patient symptoms, identification of patient signs, adequate healthcare staffing and timely intervention. ‘Failure to rescue’ most frequently occurs in surgical procedures with higher risk of adverse events, which include procedures such as general, vascular and thoracic surgical procedures. (Massarweh et al, 2017)
The incidence of adverse events linked to failure to rescue in the Australian acute healthcare environment
Adverse events such as post-surgical complications, infection, treatment rejection and reactions to medication may be linked to failure to rescue, and are evident to varying degrees in the Australian acute healthcare environment. This can range from small errors in the application of routine medications and anaesthetics, to neglect of post-operative symptoms such as breathing difficulties and tachycardia, which may be indicative of more serious conditions such as pulmonary embolism.
Incidence of adverse events in the Australian acute healthcare environment vary significantly. A study by Assareh et al (2014) had found that the incidence of adverse events linked to failure to rescue in the Australian acute healthcare environment was marked by significant geographical variance. (Assareh et al, 2014) Based on a population based study of 4.3 million elective surgical admissions across New South Wales, Australia from 2002-2009, Assareh et al (2014) found that of 153 local government areas, about 20% (31 areas) featured patients who were exposed to excessive adjusted failure-to-rescue risk of 10 to 50%, while about another 20% had a lower adjusted failure-to-rescue risk of 10%, when compared with the national risk level of 14%. (Assareh et al, 2014) This may be explained by the findings of Ghaferi et al (2009), who had concluded that incidence of adverse events did not directly result in failure to rescue and death, and that rather, it was the inability to quickly identify and respond to the deterioration caused by such adverse events that led to failure to rescue. (Ghaferi et al, 2009) A similar study also found that hospitals with high complication and adverse incidence rates tend to have lower failure to rescue rates in Australia, likely because nursing staff in high adverse incidence rate environments have the experience and situational awareness developed to prevent failure to rescue incidents. (Ghaferi et al, 2011)
The variance in such incidence of failure to rescue across Australian acute healthcare is a result in the quality and adequacy of healthcare practitioner staffing in these areas. For example, insufficient staffing results in nurses having to manage the needs of a large
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