Critical Evaluation of Failure to Rescue in Acute Healthcare Settings

This essay critically evaluates the concept of 'failure to rescue' within the context of deteriorating patients in acute healthcare settings, as defined by the provided assignment brief for 3803NRS Interprofessional Practice and Patient Safety. It begins with an introductory paragraph outlining the assignment's aim and defines 'failure to rescue' as the failure to prevent clinically significant patient deterioration. The essay then discusses the incidence of adverse events linked to failure to rescue in the Australian acute healthcare environment, highlighting factors such as hospital quality and patient age. It analyzes and evaluates the consequences of failure to rescue for patients, families, and healthcare staff, including physical and psychological impacts. Finally, the essay explores and evaluates nursing strategies to mitigate the risk of failure to rescue, such as increasing nurse-to-patient ratios and implementing retrospective analysis of deterioration cases to identify risks and improve patient outcomes, emphasizing the importance of early escalation of care. The essay draws upon current literature to support its arguments, and to provide a thorough understanding of the topic.

Running head:COMPLEX CLINICAL CARE
Failure to Rescue
Name of the Student
Name of the University
Author Note

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Introduction and Definition
The term’ failure to rescue’ originated to measure the quality of care that is given
post-surgery immediately and it was meant to evaluate the staff’s ability to stabilize a person
after they have deteriorated. It is evident that sometimes in the task of carrying out the
surgery, complications do occur. There is a systematic and progressive way to rescue the
patient and stabilize them. However, sometimes due to one factor or the other, it is not
successful. This essay aims to shed light on the research related to ‘failure of rescue’ of
deteriorating patients in acute healthcare facilities, the impact of it on the patients, families,
and the healthcare staff, as well as the strategies that are utilized to lower the risk of failure to
rescue.
Failure to rescue can be referred to as the failure to stop the clinically significant
deterioration of the patient from a medical complication or disease, which may result in
permanent disability and sometimes even death (Psnet.ahrq.gov., 2020). It is also described
as the proportion of death among patients who suffer from treatable complications after
undergoing surgery. ‘Failure to rescue’ acts as an indicating factor of the quality of patient
care provided in the healthcare facility (Barmparas et al., 2018). Here a higher FTR rate
relates to a lower quality of patient care by the healthcare staff.
Adverse Events directly related to Failure to Rescue in Acute Healthcare
Facilities of Australia
It has been seen that maximum failure to rescue occurs amongst surgical patients in
acute healthcare facilities. In a study conducted in many acute care facilities in Australia, a
significant percentage of the patients who faced FTR-related problems died prior to or during
hospitalization (Ahmad et al., 2017) Several factors are related to the incidence of FTR which
includes quality of hospitals, age of the patients (it was significantly higher in adults aged 70

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or older) (Hravnak et al., 2017). Adverse events can be described as events that precede the
consequence of failure to rescue. These adverse events usually include trauma or surgical
procedures in acute care facilities (Holena et al., 2017). In Australia, around 15-20% of
patients who undergo surgery are faced with some sort of complications, with approximately
5% to 7% of them not making it up to discharge. It was found that FTR has the highest
incidence amongst the patient safety indicators, which is about 91.13 in 1000 cases.
Several events such as acute myocardial infarction, complex surgeries such as liver
transplant that develop complications, are regarded as adverse events resulting in failure to
rescue if death occurs (Silber et al., 2018). The majority of the adverse events are related to
surgery in an acute healthcare facility, followed by the occurrence of medications
(Schwendimann et al., 2018).
It must be remembered that the disease and the nature of the operation often has a
profound effect on whether the patient can be helped or not. Different procedures have
different failure to rescue rates. For example, Sarcopenic Obesity has a higher risk of failure
to rescue than many other complications (Pecorelli et al., 2018). Pancreatectomy is often the
cause of failure to rescue in older patients (Tamirisa et al., 2016).
These are related to many factors, as well. These include a relationship with nurse and
staff volume in the hospital systems, as well as nursing education. It has been seen that lower
staff volume relates to higher failure to rescue. Some patient factors have also been deemed
responsible such as their age, nature of the adverse event, and others (Hatchimonji et al.,
2019). The nurse-to-patient ratio is extremely important for administering quality care and
rapid response to the patients in case they deteriorate. The teaching status of the hospital and
the availability of advanced technology also plays a role in the occurrence of FTR. So it is
evident that hospital characteristics play a huge role in the rate of failure to rescue (Sheetz,

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Dimick & Ghaferi, 2016). Another factor can be attributed to the delayed escalation of care
and the absence of the response to care in time. Time is of the essence in critical situations,
and thus steps must be taken as soon as possible. Delay in the same can lead to irreversible
consequences, as shown by many studies.
Evaluation of the consequences of Failure to Rescue
Needless to say, failure to rescue is never a welcome event for anyone. It has a
significant effect on the patient and their families, and the nurses must take responsibility. It
has been observed that the patients face post-surgical complications very often and those
facing more than one complexity cannot be saved the majority of the time. A small
percentage of patients who survive have a much-diminished quality of life and shortened
lifespan. Some patients face untreatable complications after the failure to rescue occurs, and
many of them face multi-organ failure. This has an immense effect on the patient
(Psnet.ahrq.gov., 2020). The permanent disability that occurs in many cases of living patients
also tends to have a severe psychological effect on the patient. Such an experience is
traumatizing for the patient, and it is a real possibility that the patient will likely develop
some mental issues from it. They often tend to become depressed and tend to face
hopelessness. Some feel like they have lost a part of themselves and go through despair.
These psychological reactions may also include severe disorders like post-traumatic stress
disorder.
Apart from the obvious effect on the patient, it is critical to remember that the family
faces a huge loss as well. So the consequences on the family must also be considered. It has
been seen that families of the patients often have the risk of developing post-traumatic stress
disorder after the incident. It would put significant pressure on the family members,
especially if they were close. Some families tend to blame healthcare professionals for failing

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to save their loved ones. Many nurses have said that they tend to have a meeting with the
families to help them cope with the incident as it is often a very painful time for them.
Finally, for the healthcare system and the staff, the impact of failure to rescue cannot
be denied. Failure to rescue is considered to be a quality-of-care indicator for the hospitals,
and reducing the rate of FTR is a common target of all healthcare facilities. Lower failure to
rescue will signify that they can provide good quality of care to the patient and is capable of
managing/resuscitating a patient after complexities occur during surgery. This refers to lower
post-operative mortality of the facility and assures the patients that they will be taken care of.
So, from a completely economical point of view, the hospital will suffer by the loss of
patients due to lower trust. Apart from that, it also has an impact on the staff in general. It has
been seen that the reaction of the nurses towards death from failure to rescue varies based on
the person and circumstances. This also depends on whether the nurses think that there was
an error on their part, whether the death was unexpected or not. It must be remembered that
the nurses have a very important factor in the reduction of the risk of failure to rescue by
early escalation and necessary interventions. So it is possible that the nurses feel responsible
for the disability or death caused to the patient (Bacon, 2017).
Nursing Strategies to lower the risk of Failure to Rescue
In order to prevent the phenomenon of failure to rescue, the healthcare staff must
adopt different strategies. The first and major step to be taken is to increase the nurse-to-
patient ratio. It has been seen very often that a low number of hospital staff relates to more
failure in rescue cases (Ward et al., 2019). This may be due to a higher number of nurses
being present to care for each patient and to monitor their symptoms. This can lead to an
early escalation of care as someone is always present to monitor and care for the patient. This
number does not relate to more complications, but rather the ability of the nurses to rescue

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the patient in time, thus reducing the overall FTR rate. This also occurs due to proper
teamwork by the nurses and the appropriate delegation by the nursing leaders. The more
number of nurses that are on duty, the smoother the process can be. In healthcare facilities, it
can be seen that better organizational dynamics can lead to better care for the elderly (Ghaferi
& Dimick, 2016). The reduction of the FTR rate relates to a better quality of care and overall
better patient outcomes of a care facility. To further emphasize this, there are multiple studies
that imply that inadequate staffing directly relates to the issue of failure to rescue (Simpson,
2016).
Another important strategy is the retrospective analysis of the deterioration cases.
This refers to using the data from the previously recorded instances of failure to rescue in
order to identify the potential cases and the risk factors. Here, the characteristics of the
previously deteriorating patients are collected as information. This included the diseases, the
complications as well as the age of the patients. For example, it was seen that coronary artery
disease, as well as congestive heart failure, was the most common condition amongst the FTR
patients. The heart rate, temperature, and ion levels can be narrowed down for coming up
with the riskiest vitals for FTR. As for age, it was seen that a majority of patients who faced
deterioration were above the age of 70. However, it must also be remembered that it is not
easy to isolate the cases of FTR and the factors for each case as there may be a number of
reasons why the patient could not be rescued. This may include negligence or incompetence
of the nurses, though it is unlikely. It may also include environmental factors or medical
errors. If these factors and symptoms can be adequately identified, the nurses can ‘escalate
for care,’ which means that they voice their concerns about the patient needing additional
attention. An early escalation can ensure that the rescue process starts early (Ghaferi &
Dimick, 2015). It has been seen that an early escalation can often cause reduction in the
chances of failure to rescue. Early intervention will lead to a better quality of care and thus

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reduce the risks. A prompt and elevated response to adverse effects can no doubt increase the
chances of a patient being successfully rescued.
Conclusion
From the above essay, we can conclude that there are various factors that are related
to the rate of failure to rescue in different healthcare facilities. Primarily, the deterioration of
the patients is caused by surgical complications or even sudden adverse effects such as
myocardial infarction. Certain process and protocols should be followed in order to stabilize
the patient, but they do not work all the time. This may be due to the nature of the
complication, the error in treatment, the delay in escalation, or nursing errors. These instances
have a profound effect on the patients, if they survive, as they tend to be disabled for life. For
obvious reasons, it has an immense impact on the family as well. The staff may suffer as well
due to psychological or professional reasons, as this tends to increase the FTR rate of the
healthcare facility. A higher healthcare rate points towards the lower quality of care. There
are few strategies in order to prevent the failure to rescue rate. The major strategy is to
increase the nurse-to-patient ratio as it has been seen that staff inadequacy is often the reason
for higher failure to rescue. Secondly, there is a need of analysis of the previous cases and
evaluating the symptoms. This will ensure that the nurses can notice whenever a patient is in
risk of deterioration, and they can conduct an escalation in care early. These strategies, along
with others, will ensure that minimal patients lose their lives due to failure to rescue. This
will also result in better patient care of the healthcare facility and, thus, better patient
outcomes.

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Reference
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