How powerful is failure to rescue as a global metric? Not as powerful as a commitment to measurement

In a much-discussed study published in 2009, Dr Ghaferi and colleagues¹ revived the concept, originally described in the early 1990s by Jeffrey Silber and colleagues,² of 'failure to rescue'. Ghaferi and colleagues¹ used a prospective, multicentre clinical registry organized by the American College of Surgeons (ACS-NSQIP) to rank hospitals by mortality quintiles. They then evaluated adverse events and noted that across the different mortality quintiles the risk of an adverse event was remarkably consistent. What differed with respect to mortality was not so much the likelihood of a complication, but the ability of a hospital to 'save' a patient who experienced a complication. Hospitals in the lowest mortality quintile had very similar rates of both minor and major complications to those in the highest mortality quintile, yet had half the rates of death. They concluded that 'failure to rescue' patients with complications in the higher mortality quintiles represented an opportunity for improvement; it was not the complications per se that killed patients, but the inability to quickly recognize and respond to their deterioration.

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