Complex Clinical Care and Failure to Rescue

Running head: COMPLEX CLINICAL CARE
Complex clinical care
Name of the student:
Name of the University:
Author’s note

1COMPLEX CLINICAL CARE
Introduction:
Although every hospital experiences a situation in which patients develop complications,
the quality of care is understood from the quality of response to adverse event. A high quality
response is reflective of the fact that health care professionals have taken the appropriate step to
stop the transition of event from an initial serious complication to a progressive cascade. A
situation in which initial complication turns to a serious adverse events leading to death for
patient is known as ‘failure to rescue’ (Ghaferi & Dimick, 2015). Hence, as part of quality
improvement and patient safety initiatives, registered nurse plays an important role in identifying
complications on time and preventing failure to rescue related events. The essay looks at the case
scenario of Mr. Peter, a 65 year old man who developed major complications after falling in the
bathroom during the hospital stay after knee replacement surgery. The essay analyzes the barriers
faced by registered nurse in failing to rescue and evaluation of strategies taken by nurse to
overcome barriers to promote safety of Mr. Peter.
Define failure to rescue:
‘Failure to rescue’ is defined as the inability to prevent death after the development of
complications in patients (Johnston et al., 2015). The issue can be understood from an example.
For example, a woman undergoes hysterectomy and develops breathing problem on the second
day post operation. Inability to identify that the symptom has been caused by pulmonary
embolism and failure to perform appropriate testing resulting in fatal complication defines a
situation relevant to failure to rescue.

2COMPLEX CLINICAL CARE
Incidence of adverse events linked to failure to rescue in Australian hospital settings:
The case scenario is related to Mr. Peter, a 65 year old man who was admitted to the
hospital for a knee replacement surgery. The patient developed serious injuries due to fall in the
bathroom. The incidence occurred because the handover nurse who was supposed to provide
assistance to Mr. Peter had to rush off due to some emergency clinical work in the next ward.
This negligence and the failure to identify high risk of fall in patient led to serious complication
for Mr. Peter. He sustained injuries in his knee again and he finally died because of developing
major complications in surgical part of the knee. This failure to rescue event occurred just
because the registered nurse did not conduct fall assessment and took necessary precaution to
promote safety of the patient during the hospital stay. Such form of negligence or failure to
identify complication lead to failure to rescue events in Australian hospital setting. A recent
survey by AIHW has indicates that adverse events in Australian hospitals have increased. 4.8
from the period between 2007-2008 and 2015-2016, the rate of adverse events has increased
from 4.8 to 5.4 per 100 separations. Another vital finding is that adverse events are most likely to
occur in surgical admission than in non-surgical admissions. The adverse events in surgical
admission are linked to failure to rescue and the rate of such incidence is 7.7 per 100 separations.
(Australian Institute of Health and Welfare, 2018). These statistics suggest the need to analyze
registered nurse preparedness in preventing failure to rescue events.
An analysis of the consequences of failure to rescue for the patient, the patient’s family and
the health care system:
The incidence of failure to rescue, henceforth referred to as FTR can have significant
impact on patients, their family and the healthcare system. Patients admitted in hospitals are

3COMPLEX CLINICAL CARE
directly affected by FTR events as because of such complications, they suffer physically as well
as mentally. In case of Mr. Peter, failure to identify high risk of fall was associated with fall and
severe complications for Mr. Peter. It increased both his sufferings and medical cost. Ghaferi and
Dimick (2016) explains that elderly people undergoing surgery are most likely to suffer because
of FTR event as mortality rate increase from 4% in patients above 65 years to 15% in patients
older than 8- year. Patients more than 65 years of age account for about 80% of all surgical
deaths. This is a significant statistics which indicates that patients particularly elderly die because
of poor preparation of the surgical patients in the preoperative setting. Increase in adverse events
related to FTR in any clinical setting puts great question mark on hospital’s ability rescue
patients from major complications. Patient’s and family and loved ones are also mentally and
emotionally influenced by the trauma inflicted on patients due to FTR. For example, in case of
Mr. Peter, his family had to deal with additional medical expense and emotional stress due to
complications in surgical areas. It not only increases unnecessary medical cost, but also creates
mental stress for families (Southwick, Cranley & Hallisy, 2015). In case of patients who lost
their lives due to FTR, resentment and the period of getting over the grief is a difficult part of
survival for people.
The occurrence of FTR is associated with great burden for the health care systems too.
This is because FTR is a patient safety and quality indicator and increase in such events creates
additional stress and workload for health care administrators and health care professionals. For
example, in case of the scenario of Mr. Peter, the nurse on duty was directly responsible for the
event and the nurse has to go through strict action and extra care burden related load. The direct
blame of such events comes on the staffs involves because FTR rate is strongly influenced by
modifiable factors like education level of nurse, nurse-to-bed ratios and physician board