Cochrane Database of Systematic Reviews

Running head:FAILURE TO RESCUE
Failure to Rescue
Name of the Student
Name of the University
Author Note

1FAILURE TO RESCUE
Introduction
In the vast number of patients that the nurses treat each day, it is no surprise that some
patients may be more difficult or complex than others. More often than not, older patients
prove to be more complex and harder to care for. They face more complications and are
harder to stabilize. These patients often undergo 'deterioration'. Deterioration can be referred
to as the process of physiological destabilizing of the body due to which the patient becomes
more ill or critical (Lavoie, Pepin & Alderson, 2016). The steps utilized for stabilizing the
patient and lowering the risk to their life are known as 'rescue.' This essay aims to focus on
the critical evaluation of failure to rescue in the context of an acute healthcare environment.
Definition
Failure to rescue can be defined as the inability of the nurses to stabilize a patient and
bring him back to a healthier condition after the patient has deteriorated. It can also be
described as the healthcare staff being unable to stop the clinically significant deterioration of
a patient. Failure to rescue may have the gravest consequences, usually leading to death. If
the patient survives, they typically have disability for the rest of their lives. Nowadays, failure
to rescue is considered to be an indicating factor that measures the quality of care that the
hospitals can provide to their patients (Sheetz, Dimick & Ghaferi, 2016). This is estimated by
the number of patients the staff has failed to 'rescue' after the patient's condition has
deteriorated.
Adverse Events in Australian Healthcare leading to Failure to Rescue
It is critical to remember that deterioration in patients does not just occur out of the
blue, but rather something stimulates it like an adverse event during surgery or treatment
(Hravnak et al., 2017). The events which occur just before the deterioration and ultimately

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lead to the failure to rescue are termed as ‘adverse events’. These adverse events may be of
many types, but very commonly, they include cardiac or respiratory arrest. Some patients
may also go into a state of shock, which is also considered to be an adverse event (Padilla &
Mayo, 2018). These events can be identified by understanding the cues that point towards an
adverse event. It has been seen that adverse events tend to complicate about 7.5–16.6% of
patient's health in acute care (Martin, Jones & Wolfe, 2017). Cardiac arrests and respiratory
arrests have many cues that include wheezing, coughing, communication difficulty and chest
pain amongst others. Shock can be identified by cold, sweaty skin, tachycardia and
hypertension (Mushta, Rush & Andersen, 2018). More adverse effects may include COPD,
Cirrhosis and acute Myocardial Infarction. There are a number of steps that finally lead to the
failure to rescue. This include lack of nursing care and monitoring, failing to recognise the
cues of deterioration, delayed escalation of care as well as failure of appropriate intervention
by the nurses. These lead to the patient's safety being compromised, and thus the patient faces
death or disability for life.
Around half of the patients in acute care of Australia are older adults with complex
healthcare needs. It is quite possible that they might face adverse events leading to
deterioration. The incidence of failure to rescue is also much higher in older adults than that
of their younger counterparts. It is also possible that the nurses are unable to give extra
attention to older patients as they require. This is because older patients slow down overall
patient care. Some other factors that may lead to a failure to rescue, including the nature of
the complication, delay in the escalation of care and quality of nursing care. According to a
study conducted in Australia, the largest failure to rescue occurred in the knee or hip
replacement, and cholecystectomy patients (Subbe & Barach, 2017). It has been noticed that
recently, the complexities among the patients have increased in acute care settings. This may
be due to the increased rate of patients suffering from multiple issues as well as shorter

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hospital stays among the patients (Kentischer et al., 2018). These factors often serve in
increasing the failure of rescue as well, since it has been seen that patients with more than one
complexity have a higher rate of failure to rescue.
Frequently, factors related to the healthcare system or the facility specifically has also
been linked to the cause of failure of rescue. This may include a lack of infrastructure of the
hospital or the lack of organization. But according to the majority of the research that has
been conducted, the main culprit is the staff volume as well as a lower nurse-to-patient ratio.
This often leads to inadequate care and thus failure to rescue.
Impact of Failure to Rescue on the Patient, their Family and Healthcare
Staff and System
Failure to rescue is a serious issue, and it has very harsh effects on different people.
Firstly, the patients face the burden of being disabled for the rest of their lives, which is if
they survive. This can be a hard thing to come in terms of for any individual. Mortality is the
most immediate cause of failure to rescue. In the patients were permanent disability, this
causes severe psychological issues and trauma.
Since failure to rescue often leads to death, the psychological effect on the patient's
family is undeniable. The families face obvious grief from the death of a loved one, and this
has an immense psychological impact on the family. The family members may even blame
the staff for failing to rescue, especially if they think the complication could have been
prevented. In some cases, the nurses tend to talk to the family to help them process their grief.
Since failure to rescue is used as an indicator of measuring the quality of the
healthcare and competence of the nursing care, it has often had profound effects on the
healthcare facilities (Sheetz, Dimick & Ghaferi, 2016). A lower failure to rescue rate signifies
that the facility is good at stabilizing deteriorating patients and has less patient mortality. This

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gives a sort of hope to the patients as well as the family that they will be taken care of. Thus,
a lower FTR leads to the facility having more patients and also signifies better patient
outcomes. However, there is also a question of whether the FTR is a completely unbiased
way to measure the quality of the care of a facility or not. Sometimes, the death may be
directly related to the complication of some other factor but still misclassified as FTR. Apart
from the effect on the facility, failure to rescue also has a significant impact on the nurses. In
a study conducted on the nurse's reactions regarding patients dying, most of them spoke about
their emotional wellbeing. The common responses often revealed their shock at patients
dying unexpectedly, and the psychological effects it had on them, despite facing death
regularly in their profession (Bacon, 2017). At the end of the day, failure to rescue has
different effects on different groups of people and it is never psychologically pleasant.
Strategies to Reduce the Risk of Death by Failure to Rescue
Since Failure to Rescue rate is a crucial indicator of the quality of patient care of the
facility, several strategies have been adopted to reduce the risk of mortality by failure to
rescue. These strategies may involve the patient, their families as well as the whole healthcare
system and the staff. These strategies can be described as follows.
The first strategy has to do with utilizing a more diverse group of nurses as well as a
higher number of nurses. Adopting an interdisciplinary approach in the critical care unit has
often proved useful in treatment processes as well as in preventing failure. When
professionals with different experiences and expertise, take care, and monitor a patient, it is
much more likely that they will be able to find the cues that the patient is deteriorating.
Interprofessional collaboration has often proven to be extremely useful in the critical care
unit (Reeves et al., 2017). It was observed that it provided better patient outcomes than the
usual care administered by the nurses. For example, if nurses explicitly trained for geriatric

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patients are assigned to care for the older patients, they will be able to care for them much
better. On the other hand, the need for a higher number of nurses is very evident from recent
literature. Most studies that have been undertaken show a clear correlation between lower
amounts of nursing staff with a higher rate of failure to rescue. This is very obvious as the
lack of staff often leads to delay in care as well as lower availability in nurses. If the number
of nurses increases in a facility, the overall nurse to patient ratio will increase as well. Thus
this will lead to nurses being able to prioritize the patients more as they will have a lesser
number of patients allotted to them. Hence, they will be able to monitor the cues of
deterioration much earlier and thus administer an escalation in care earlier. This will lead to a
lower rate of failure to rescue as the procedure can be started before it is too late. A larger
team will also enable the nurses to seek help whenever they deem necessary. This will also
ensure that the nurses can spot poor quality care, report and rectify the same (Ion, Jones &
Craven, 2016). Having a large interdisciplinary team can be critical in case of emergencies
and saving a patient.
The second strategy has to do with increasing education relating to the topic. The
nurses must be adequately trained on how to handle the situations when an emergency arises.
They must also be taught which cues to look for in the patients. They must be taught what
exactly means to have a deterioration in a patient and what course of action should be taken.
Only theoretical knowledge is not enough, so the nurses must be trained in the practical
environment. This can be done via simulation. Education by simulation has long been a very
successful way of nursing education. This can be especially useful for the education of the
new graduate nurses
(Herron, 2018) as well as to increase the knowledge and practice of the registered nurses.
Simulation tests can also be taken to assess the expertise of the nurses and to evaluate how
well they react to emergency patient situations. In a study conducted among the nurses, three

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simulated patient scenarios were formed, which assessed the reaction of the nurses. It was
noticed that the nurses failed to adhere to the guidelines and best protocols of care (Koers et
al., 2020). So if a simulated practice was regularly done in the facilities, the nurses can be
more alerts and habituated with what exactly to expect. This sort of simulated scenario can
also make the nurses more comfortable with quickly taking up the task. The ideal division of
labour can be practiced, which will definitely result in better patient outcomes. It will also
help the newly graduated nurses become freer with administering care to the patient
(Bickhoff, Sinclair & Levett-Jones, 2017). This will, in turn, enhance the quality of care and
thus reduce the risk of failure to rescue.
Conclusion
From this essay, it can be concluded that many factors are related to the failure to
rescue in the healthcare facilities, mainly the adverse events that occur during treatment or
surgery. The incidence of failure to rescue is much higher in older patients. The occurrence of
such failure to rescue can be prevented, or the risk can be lowered by undertaking certain
strategies. The first strategy may be an increase in the number of nurses as well as involving
nurses with different expertise.. Another strategy is to increase nursing education and
practical knowledge with the use of simulation These strategies, along with others, can lower
the risk of failure to rescue and, in turn, increase the quality of nursing care administered by
the healthcare staff at that facility.

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Reference
Bacon, C. T. (2017). Nurses' experiences with patients who die from failure to rescue after
surgery. Journal of nursing scholarship, 49(3), 303-311. DOI:
https://doi.org/10.1111/jnu.12294
Bail, K., & Grealish, L. (2016). 'Failure to Maintain': A theoretical proposition for a new
quality indicator of nurse care rationing for complex older people in
hospital. International journal of nursing studies, 63, 146-161. DOI:
https://doi.org/10.1016/j.ijnurstu.2016.08.001
Bickhoff, L., Sinclair, P. M., & Levett-Jones, T. (2017). Moral courage in undergraduate
nursing students: A literature review. Collegian, 24(1), 71-83. DOI:
https://doi.org/10.1016/j.colegn.2015.08.002
Herron, E. K. (2018). New graduate nurses' preparation for recognition and prevention of
failure to rescue: A qualitative study. Journal of clinical nursing, 27(1-2), e390-e401.
DOI: https://doi.org/10.1111/jocn.14016
Hravnak, M., Mazzoccoli, A., Bose, E., & Pinsky, M. R. (2017). Causes of failure to rescue.
In Textbook of rapid response systems (pp. 95-110). Springer, Cham. DOI:
https://doi.org/10.1007/978-3-319-39391-9_10
Ion, R., Jones, A., & Craven, R. (2016). Raising concerns and reporting poor care in
practice. Nursing Standard, 31(15). DOI: 10.7
10.7748/ns.2016.e10665748/ns.2016.e10665
Kentischer, F., Kleinknecht‐Dolf, M., Spirig, R., Frei, I. A., & Huber, E. (2018). Patient‐
related complexity of care: A challenge or overwhelming burden for nurses–a

8FAILURE TO RESCUE
qualitative study. Scandinavian journal of caring sciences, 32(1), 204-212. DOI:
10.1111/scs.12449
Koers, L., van Haperen, M., Meijer, C. G., van Wandelen, S. B., Waller, E., Dongelmans,
D., ... & Preckel, B. (2020). Effect of cognitive aids on adherence to best practice in
the treatment of deteriorating surgical patients: a randomized clinical trial in a
simulation setting. JAMA surgery, 155(1), e194704-e194704. DOI:
10.1001/jamasurg.2019.4704
Lavoie, P., Pepin, J., & Alderson, M. (2016). Defining patient deterioration through acute
care and intensive care nurses' perspectives: Defining patient deterioration through
ACU and ICU nurses' perspectives. Nursing in Critical Care, 21(2), 68-77.
DOI:10.1111/nicc.12114
Martin, C., Jones, D., & Wolfe, R. (2017). State-wide reduction in in-hospital cardiac
complications in association with the introduction of a national standard for
recognising deteriorating patients. Resuscitation, 121, 172-178. DOI:
https://doi.org/10.1016/j.resuscitation.2017.08.240
Mushta, J., L. Rush, K., & Andersen, E. (2018, January). Failure to rescue as a nurse‐
sensitive indicator. In Nursing forum (Vol. 53, No. 1, pp. 84-92). DOI:
10.1111/nuf.12215.
Padilla, R. M., & Mayo, A. M. (2018). Clinical deterioration: A concept analysis. Journal of
clinical nursing, 27(7-8), 1360-1368. DOI: 10.1111/jocn.14238
Reeves, S., Pelone, F., Harrison, R., Goldman, J., & Zwarenstein, M. (2017).
Interprofessional collaboration to improve professional practice and healthcare
outcomes. Cochrane Database of Systematic Reviews, (6). DOI:
https://doi.org/10.1002/14651858.CD000072.pub3

9FAILURE TO RESCUE
Sheetz, K. H., Dimick, J. B., & Ghaferi, A. A. (2016). Impact of hospital characteristics on
failure to rescue following major surgery. Annals of surgery, 263(4), 692. DOI:
10.1097/SLA.0000000000001414
Subbe, C. P., & Barach, P. (2017). Failure to rescue and failure to perceive patients in crisis.
In Surgical Patient Care (pp. 635-648). Springer, Cham. DOI: 10.1007/978-3-319-
44010-1_37