L. Kuo1, E. Kaufman2, J. Pascual1, P. Reilly1, N. Martin1, P. Kim1, D. N. Holena1 1Hospital Of The University Of Pennsylvania,Surgery,Philadelphia, PA, USA 2Cornell University,Ithaca, NY, USA
Introduction: The Failure to Rescue (FTR) rate is defined as the conditional probability of death after complications and is felt to reflect a center’s ability to ‘rescue’ patients after complications occur. Implicit in this terminology is that rescue is possible and death therefore represents a failure. We sought to evaluate the relationship between preventability and FTR with the hypothesis that many deaths meeting the definition for FTR in trauma would be judged non-preventable by structured explicit review and expert panel consensus.
Methods: We merged registry data from 2009-2013 at an academic level I trauma center with the results of all adjudications from morality review panels for the same time period. Explicit review of charts by the mortality panel included attention to the timing and appropriateness of care rendered. The preventability of each death was determined by consensus of panel of trauma surgeons as part of peer review. FTR events were defined as deaths occurring after any registry-defined complication. Characteristics of patients sustaining FTR events were compared between groups using chi-squared and Mann-Whitney test as appropriate.
Results: 1,339/12,295 (10.9%) of patients had a complication. Of these, 146/1339 died, for a FTR rate of 10.9%. Of FTR deaths, 118 (81%) were judged to be Non-Preventable (NP), 19 (13%) were judged Potentially Preventable (PP), and 9 (6%) were judged to be preventable (P) by peer review. Deaths judged to be preventable were more likely to have occurred in patients sustaining penetrating trauma, those with high GCS component scores, and with higher predicted survival by TRISS methodology (Table 1).
Conclusion: In the trauma setting, only 20% of deaths meeting the definition of failure to rescue were judged to be preventable or potentially preventable by mortality review panels. The current definition of the FTR metric may not be a valid measurement of the quality of care in the trauma population and revision prior to use for benchmarking of care in this setting is warranted.
