Failure to Rescue in Nursing

This article discusses the concept of failure to rescue in nursing and explores strategies to prevent it. It examines the impact of failure to rescue on patient outcomes and highlights the importance of interprofessional practice in enhancing patient safety.

Running Head: FAILURE TO RESCUE IN NURSING
Failure to Rescue in Nursing
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Failure to Rescue in Nursing
Introduction
The concept of failure to rescue captures the notion that even though not every problem
in healthcare is preventable, healthcare systems are required to rapidly identify as well as treat
the condition when they take place. Even though every healthcare institution has surgical
challenges, the quality of response to the negative events differs broadly across hospitals. An
effective response is key to stop the potential transition to a progressive cascade of negative
happenings from initial serious problems which can result in death or failure to rescue. As most
physicians know and acknowledge, the tragic result of an individual’s medical trajectory is not
sudden or unexpected. Rather, these failures happen before a steady accumulation of small
medical clues (Bacon, 2017). The challenge of individuals developing complications during the
process of hospitalization as well as suffering from mortality and morbidity has normally been
present. Presently, intense attention has been put on this phenomenon as it is believed to be the
primary cause of hospital mortality which is preventable. The paper will discuss in great detail
the concept of failure to rescue as it is linked to the deteriorating individual in the acute
healthcare context. The paper will also evaluate strategies used by nurses in preventing this
occurrence in the healthcare institutions including the role of interprofessional practice in
enhancing the safety of the patients. The paper will also investigate barriers which affect the
execution of intervention strategies for failure to rescue.
The adverse events and analysis of the Failure to Rescue in Australia
Failure to rescue happens when a generally healthy patient who has been hospitalized
deteriorates, develops complications and consequently suffers an adverse medical consequence.

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The deterioration and complications mostly entail subtle and sometimes not subtle signs and
symptoms which are dismissed as not so serious or which are missed by the nurses entirely
(Garvey, 2015). It is key to note that nurses are very key in preventing failure to rescue
challenges. There are four prevention aspects, that is, accurate and careful monitoring, timely
recognition of a complication, an effective and timely intervention which is based on the
complication, and the activation of response team as required. Each of the four requires time for
direct observation of the patient. Thus, few numbers of staffs, as well as short staffing, has the
potential to reduce the ability of healthcare to spend ample time at the bedside.
Negative events like loss of lives, damage to the critical physiological parts, depression
and physical damages during patient hospitalization and surgical complications are quite
common in clinical settings. In the United States of America, about one-fifth of individuals who
underwent in 1998 lost their lives because of the treatable and preventable complications (Chung
et al. 2017). In Australia, 20% of the individuals have experienced at least one health
complication after undergoing surgery while about 8% of them lost their lives before discharge
(Assareh et al. 2014). Effective treatment and timely identification of the complication once it
happens can prevent loss of lives. The rate of failure to rescue differs across individuals and
healthcare institutions with various features (Wied et al. 2018). Aging individuals, as well as
those having higher pre-operative comorbidities, have a greater risk of complication as well as
the risk of loss of lives after surgery. Empirical studies conducted in United States of America,
Australia and other European hospitals have revealed that individuals who have undergone
surgery in healthcare institutions with a high death rate did not suffer from excessive medical
complications compared to individuals who were in healthcare facilities with lower death rates
yet were less likely to have a quality life due to lower quality of care. Failure to rescue is

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influenced by a host of healthcare institution structures as well as process, and it has been linked
to the patient-nurse ratios, poor or limited access to radiology services, training of medical and
nursing staff as well as the availability of emergency operating room (Mushta, Rush & Andersen,
2018).
There are empirical data to suggest the association between the provision of quality of
critical care and failure to rescue even though the evidence of the postoperative care admission
benefit is erratic. One of the most broadly debated failure to rescue determinant is the
relationship between volume and outcome. The relationship between mortality and hospital
volume has been demonstrated for intricate surgical procedures as well as common clinical
emergencies (Chen et al. 2019). It should be noted that such observations have influenced
reconfiguration of services in different countries including Australia yet sparked a lot of
controversies. Failure to rescue has negative implications even to the families of the patient
especially when the patient loses his or life, physically or physiologically damaged. The family
become mentally affected like becoming depressed.
The relevance of failure to rescue rates
Certain deaths in a healthcare facility are inevitable. Most of the mortality rates between
healthcare facilities have little to do with variations in the quality of healthcare which individuals
receive nevertheless, yet is more linked to the level of co-morbidity and illness of people who are
receiving treatment a well as their degree of vulnerability. Measures such as the healthcare
facility standardized death rate attempt to account for this by applying the statistical techniques;
however statistical adjustments can ever be ideal or perfect (Ou et al. 2014). Failure to rescue
provides a different way of discovering how a healthcare facility performs. For individuals
undertaking surgery, the probability of developing a process, such as pneumonia or bleeding is

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greatly associated with factors like underlying condition or age (Kim & Kim, 2018). Even
though complications are normally an outcome of characteristics of a patient, nevertheless, the
ability of a healthcare facility to effectively treat or manage a complication the moment it occurs
is highly linked to the quality of care offered. The failure to rescue indicators is usually intended
to highlight how well healthcare facilities operate once the complications happen.
The failure to rescue metric doe not indicate poor care; instead it shows where poor care
exists. The metric must be used at the healthcare institution level across the large population in
which adjustment of risk is normally difficult. Failure to rescue has been often used as an
outcome measure for different patient groups entailing liver, aortic surgery, gynecological,
gastrointestinal surgery, and even emergency surgery. Conventionally the prevention of
postoperative problems has been the basic emphasis of efforts to minimize death rates after
surgery (Watkins, Whisman & Booker, 2016). Nevertheless, with the coming of the large
projects created to enhance the quality and effectiveness of perioperative care, healthcare
professionals in Australia have identified complication management as a vital opportunity to
prevent deaths after surgery.
Barriers and Strategies to address the failure to rescue by nurses
Failure to rescue has been identified as a vital area for improving the safety of the
patients. Metrics to approximate failure to rescue rates have been created and are broadly used as
hospital quality indicators. The Agency for Health Research and Quality (AHRQ) has come up
with a measure of failure to rescue intended to solve the concerns regarding differences in
documentation among the reporting authorities as well as the fact that patient safety metrics like
complication and mortality rates, can be more an evaluation of client-related factors than quality
of healthcare (Khan et al. 2019). It should be noted that failure to rescue metrics are restricted to

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certain levels in their utility because some individuals with advanced conditions do not want
interventions that prolong their lives while certain adverse happenings are normally not
preventable. However, acknowledging failure to rescue as a vital issue and a significant quality
indicator has prompted many studies of fundamental causes as well as the development of
systematic models to address them. There are two major contributors to failure to rescue, that is,
timely or prompt response of the complication and the appropriate treatment and management.
Many studies have revealed widespread challenges in both of the areas, that is, identification of
the causes ranging from the deficiencies in the key collection of signs to prompt action in
response. There is a relationship between high nurse-to-patient ratio and low client mortality.
The association can be the result of addressing both the recognized challenges by enhancing
client monitoring as well as more prompt interventions (Fasolino & Verdin, 2015).
Moreover, empirical studies have shown a link between levels of nurse staffing in the
intensive care unit ad mortality of the patients, an effect which can be the outcome of the
provision of the right treatment and management at the right time. Enhancing the number of ICU
healthcare providers is an improvement to failure to rescue basically on the efferent limb of the
system, that is, the client either already had the negative event which required a transfer to the
ICU or the client recognized to be at high risk, thus, transferred to the ICU for its enhanced
number of staffs (Herron, 2018). It should be noted that ICU healthcare providers have been used
to recognize clients on general wards who were viewed to be at risk as a quintessential of how
extra personnel can be used on detecting a problem.
To solve the challenge of a late response, Rapid Response Team (RRT) systems were
introduced after realizing that patients show deterioration signs between six and eight hours
before a respiratory or cardiac arrest (Roney et al. 2015). Early identified has been recognized as

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the basic success determinant of the RRTs interventions. Another vital intervention for failure to
rescue is for the hospital to replace the inherently paper patient charts which have been proven as
unreliable. Paper patient charts usually get misplaced while some vital information can be
illegible or missing, thus, making it hard for the nurses to optimize care for the patients.
Healthcare facilities need to have patient data like medication usage and vital signs in electronic
form making it effortless as well as time efficient for the nurses to determine the status of the
patients. Electronic forms of patients ensure that nurses can check on the patients even when they
are physically not near them. Proactive medical surveillance tools are also the best interventions
for failure to rescue. With the client data and information in electronic form, nurses, supervisors,
and even hands-on carers can use specially created ‘dashboard views’ to rapidly identify which
clients are exhibiting warnings symptoms of medical decline and the location in which they are
(Smith, Wells, Friese, Krein & Ghaferi, 2018). Daily monitoring systems signify a more
proactive model of identifying deterioration of patients anchored on the premise that changes in
physiology can predict or indicate deterioration incidents. Various technologies have been
established for both examination and analysis of physiologic data. For instance,
electrocardiograph monitoring has been developed for cardiac patients and recently has been
extended for other patient groups at risk of suffering from cardiac dysrhythmia.
Nursing strategies involving an inter-professional practice that may be used to prevent registered
nurses from failing to rescue
Even though the availability of effective and appropriate healthcare facility and unit-level
resources is key, the significance of high-reliability teams and the structures remain unknown.
Certain empirical evidence pinpoints environmental factors linked to the effective rescue like
house officers, intensive care unit staffing models, and house officers yet a deeper

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comprehension of interdisciplinary and interprofessional clinical interactions is key to inform the
implementation and design of the ideal high-reliability surgical staff (Rao, Kumar & McHugh,
2017). For instance, in performing surgery in the clinical context, nurses usually seem to
recognize that a patient is in distress and do not respond quickly leaving the patient health to
deteriorate. Nursing staff ability to appropriately attend to the health need of the patient can be
attributed to the availability of other professional staff members and the resources, the behaviors
related to patient safety and the reliability as well as the efficacy of interprofessional team
communication (Blackburn, Harkless & Garvey, 2014).
It should be noted that a better understanding of these supportive factors like the
interprofessional relationship is key in designing effective and practical interventions for failure
to rescue. A consensus is gradually growing concerning the benefits of scores of early warning
and smart physiological monitoring of patients who have been hospitalized as promising models
to minimize rescue to failure. The approaches entail incorporating interprofessional collaboration
and person-centered approach in the interventions models of failure to rescue, and they can be
vital in the for taking care of critically ill individuals in ICUs.
Conclusion
Failure to rescue is an effective metric of global performance of healthcare in the elective
surgical society. Failure to rescue rate does vary between the worst and best-performing
healthcare centers, indicating the occurrence of preventable mortalities postoperative surgeries in
some health care systems. Initiatives by the healthcare system in Australia to enhance surgical
treatments should recognize the need for effective and safe perioperative care to minimize failure
to rescue rates. The paper states that the quality and safety of patient care has to be a priority for
Australian health agenda and the provision of healthcare. Thus, more research has to be done to

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come up with cost-effective approaches to deliver high-quality surgical treatments in an
environment with limited resources.

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