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"Failure to rescue" may become the catchphrase of the decade. The media have used it in relation to Hurricane Katrina victims and the war on terrorism; the phrase is also splashed across healthcare publications. As the methods we use to assess quality of care evolve, the examination of failure to rescue becomes part of that change. Hospitals are communicating their outcomes and consumers are asking more questions about quality before they choose a hospital.
Though it can be defined in different ways, failure to rescue generally implies the lack of an appropriate and timely response to changes in a patient's condition, by both medicine and nursing, which might have influenced that patient's outcome. These deaths could've been potentially preventable had there been a different response on the part of the healthcare team.
The reasons patients aren't rescued are complex. There may be system issues, staffing issues, inadequate levels of education and expertise among physicians and nurses, or a lack of access to the proper assistance. How we respond to changes in patient conditions is extremely important. Our patients want to know that they'll be safe and cared for if there's a problem. Nurses can be leaders in preventing hospital deaths, as we have extensive contact with patients. Researchers at the Center for Health Outcomes and Policy Research, University of Pennsylvania, are comparing hospitals' failure-to-rescue rates to examine the ways nurses influence patient outcomes. One consistent finding is that lower patient-to-nurse ratios have been linked to lower failure-to-rescue rates in hospitals.1
Changing our hospital's culture to one of transparency, which involves including nursing in mortality and morbidity discussions, will require a continued strong voice from nursing. We're intimately involved in patient care and should be equally involved when there's an instance of failure to rescue. The stories of failure to rescue should be used to teach and change future behavior. Of course, no one wakes up and thinks, "Today I'll be negligent," but our increasingly complex patients and workload have pushed the limits of our healthcare systems. An RN who's caring for eight patients on a busy surgical floor has a challenging time performing regular surveillance on all the patients. When one patient is time-intensive, a change may occur in the condition of another patient. Due to these competing interests, the nurse can't get back to assess the patient. For example, an episode of acute shortness of breath and desaturation may be missed until the patient significantly decompensates and progresses to cardiopulmonary arrest.
One part of the complex solution to this problem is to implement a rapid response team, which aims for reducing the incidence of failure to rescue and arriving at patients' bedsides before they progress to cardiopulmonary arrest. The team provides trained personnel 24 hours per day, 7 days per week, to react quickly when there's a change in patient condition. This provides additional eyes and assessment to make the correct diagnosis and begin treatment.
I encourage you to assess your hospital and think about how you and your staff take care of patients when complications arise. Is a rapid response team in place? How hard is it to get extra help at the bedside? Talk to your colleagues and quality management department and brainstorm on how best to improve this process in your hospital. Every patient deserves to be rescued, and every nurse is inherently a rescuer.
Kate J. Morse, RN, CCRN, CRNP, MSN
Editor-in-Chief, Director of Nurse Practitioners, Chester County Hospital West Chester, Pa.
1. Clarke SP, Aiken LH. Failure to rescue: measuring nurses' contributions to hospital performance. Am J Nurs. 2003;103(1):42-47. [Context Link]
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