It’s 1 a.m., and five days after his colectomy. John Doe lies in his hospital bed with a fever and increasing abdominal pain. The overnight hospital team treats him with pain medications, thinking his condition is related to delay in his bowels functioning. The next morning, he is managed with increasing doses of narcotics to treat his pain. By the same evening, he has become even more feverish and lethargic. His abdomen is palpated and he wails in pain.
The attending physician is notified and rushes John Doe to the operating room. The surgeon finds a significant bowel leak, which is washed out, and directly after the procedure Mr. Doe is taken to the ICU. Once in the ICU, he begins to develop acute respiratory distress syndrome and resuscitation begins. Despite the efforts, the team is unable to rescue him and he dies.
This fictional situation may have been preventable, especially if links between preexisting conditions and postoperative complications were identified sooner. Early recognition and timely management of serious complications, and the communication between hospital staffs in situations like this are critical. If Mr. Doe’s leak was identified sooner and appropriately managed, he may not have progressed to the downward spiral that claimed his life. In medical circles, this is called “failure to rescue.”
Recognizing every year that at least 100,000 Americans die after undergoing inpatient surgical procedures and another 100,000 patients die while hospitalized for a medical illness, a team of researchers from U-M and Dartmouth are designing a Failure to Rescue-Patient Safety Learning Lab (FTR-PSLL). The team was awarded a $4 million Agency for Healthcare Research & Quality grant to address gaps in understanding and gaps in rapid translation impeding ideal integrated rescue systems within hospitals.
With three specific aims, the team from Dartmouth will focus on innovating current technology of patient surveillance systems and creating an ideal integrated rescue system.
At U-M, Amir Ghaferi, M.D., M.S., assistant professor of surgery and director of the Michigan Bariatric Surgery Collaborative and member of the Institute for Healthcare Policy & Innovation, will lead a team that will investigate the human factors (key facilitators and barriers) that can make up the ideal rescue environment. Ghaferi was specifically tapped to lead this part of the research because of his expertise in safety-related practices and behaviors that are related to FTR.
“We are confident that there is a real need for predictive analytic methods for early indications of patient deterioration. We also know there is a need for sophisticated simulation labs that could predict the availability of information about patient status, and/or the availability and usability of tools and technology supporting timely diagnosis and treatment,” says Ghaferi. “Establishing a FTR-Patient Safety Learning Lab that is focused on creating the ideal hospital rescue system will have tremendous potential to reduce both the mortality and harm currently associated with failure to rescue.”
The project will break new scientific ground in two very important respects. The first, it will close several important knowledge gaps in understanding variation in FTR across hospitals. The second is this is the first study aimed at developing and implementing an intervention focused on reducing failure to rescue. The team’s novel approach leverages expertise from multiple medical and non-medical disciplines that will promote a broad and rich intervention that can be effectively tested in the Dartmouth simulation center and medical center.
Ghaferi said, “I hope what we find through our research will be generalizable and testable here in Michigan and elsewhere across the U.S.”