I recently talked about what happened to my father when he entered a hospital for a routine surgery to repair a fractured kneecap, had a hospital acquired urinary track infection, then got sicker and sicker until he suffered a cardiac arrest. Though medical systems are working hard to reduce hospital acquired conditions (medicare and many insurance companies will no longer pay for readmissions related to complications of hospital care) they do still occur. The urinary track infection was initially treated, but my father did not improve, and here is where the real problem started. He got a little confused, then he lost his appetite, then he didn’t urinate despite fluids, then he got weaker and weaker. A hospitalist saw him and we think he recognized that my father might be in heart failure (according to my mother he seemed to hear something and asked if my dad was on Lasix….he wasn’t), but didn’t seem to recognize that this would be new for my father. He left, did nothing, and a short time later my father had a cardiac arrest. We may never know the exact cause of his arrest, but this is appears to be a Failure to Rescue.
“Failure to rescue” is a term used in healthcare to describe a situation where a patient experiences a significant complication or adverse event, often due to a medical condition or treatment, and the healthcare system fails to recognize and intervene promptly to prevent the worsening of the patient’s condition. In other words, it refers to the system’s inability to rescue a patient from a potentially avoidable adverse outcome once a complication arises.
This concept highlights the importance of timely recognition and effective response to complications that can occur during the course of medical care. Failure to rescue is particularly relevant in cases where patients are already receiving medical treatment, and the healthcare team is responsible for closely monitoring their condition and taking action when complications arise.
Several factors can contribute to failure to rescue. A few are described below:
- Communication Breakdown: Inadequate communication among healthcare providers, between shifts, or between different departments can lead to critical information not being passed on in a timely manner. This can result in delayed responses to deteriorating patient conditions.
- Lack of Monitoring: Inadequate monitoring of patients’ vital signs or overall clinical status can prevent healthcare providers from identifying early warning signs of complications. Without timely detection, appropriate interventions may not be initiated.
- Inadequate Resources: Insufficient availability of medical equipment, medications, or personnel can hinder the healthcare team’s ability to respond effectively to complications. For example, a shortage of critical care beds might delay transferring a patient who needs intensive monitoring and treatment.
- Human Factors: Fatigue, cognitive overload, and distractions among healthcare providers can contribute to missed cues or delayed responses to deteriorating patients.
- Lack of Standardized Protocols: If there are no established protocols or guidelines for responding to specific complications, healthcare providers might not know the appropriate steps to take, leading to delays or suboptimal responses.
Two hospitals can have the same types of patients, the same types of skilled doctors and nurses, and the same types of great technologies. The difference in outcomes for patients is the ability of those teams to recognize that a patient’s status is changing, communicate that change to those who need to know, and then act to prevent further decline. Ask yourself which system do you believe you are working in?