Better care for surgical patients: Recognizing and responding to the unexpected to save lives

According to U-M research, we know that:

• Hospitals with higher death rates after surgeries do not have higher rates of complications, but do have higher rates of “failing to rescue” patients who experience them.
• Death rates among patients with major complications also vary widely between hospitals (as much as an 11-fold difference), and Failure to Rescue (FTR) is one of the key drivers of this variation.
• Therefore, more rapidly identifying and effectively responding to complications when they do occur after surgery presents a major opportunity to improve patient safety and prevent loss of life. Rescuing a surgical patient is a dynamic process. It requires interpreting and exchanging complex information in moments of crisis among care team members who have different professions and roles.

What does the evidence say about how healthcare systems can improve rescue?

What are the implications for practice and policy?

As U-M researchers continue to develop and refine effective tools to improve rescue, we must continue to evaluate where and why failures occur and ultimately implement effective prevention strategies:

Hospitals and health systems should consider:

• Implementing quality improvement strategies that increase providers’ confidence and competence with:
  • Earlier detection of major complications.
  • Effective interprofessional communication of early concerns.
• Ensuring a culture that prioritizes safety by:
  • Maximizing staffing strategies (within resource and training constraints), considering nurse:patient ratios and intensivist staffing.
  • Reevaluating workforce development to provide safe, reliable, and effective care.

Certification programs across health professions should consider:

• Enhancing training requirements that ensure greater exposure to effective rescue scenarios.

Professional specialty organizations should consider:

• Developing and implementing guidelines to improve rescue and response to crises.
• Developing networks to share information and best practices on post-operative rescue, including managing specific complications in high-risk groups.

Improving Rescue

The University of Michigan has one of only a few research programs in the country dedicated to improving rescue, evaluating effective rescue tools, and identifying opportunities for quality improvement.