S. T. Ward1, D. A. Campbell1, C. Friese2, J. B. Dimick1, A. A. Ghaferi1 1University Of Michigan,Department Of Surgery,Ann Arbor, MI, USA 2University Of Michigan,School Of Nursing,Ann Arbor, MI, USA
Introduction: Failure to rescue (FTR) is a widely accepted quality measure in surgery. While numerous studies have established FTR as the principal driver in postoperative mortality rates, specific determinants of FTR remain unknown. In this study we investigate hospital staffing strategies associated with FTR.
Methods: Using prospectively collected data Michigan Surgical Quality Collaborative (MSQC), we identified 44,567 patients between 2008-2012 who underwent major general or vascular surgery procedures. Hospitals were divided into tertiles based on risk adjusted failure to rescue rates. We then administered a hospital resource survey to surgeon champions at MSQC participating hospitals, with a response rate of 62% (32/52). Survey items included ICU staffing model (closed or open), use of board-certified intensivists, presence of surgical hospitalists and residents, overnight coverage by advanced practice providers (APP) and a dedicated rapid response team (RRT).
Results: FTR rates across the tertiles were 8.9%, 16.5% and 19.9% respectively, p <0.001. Low FTR hospitals tended to have a closed ICU staffing model (56% vs 20%, p<0.001) and a higher proportion of board-certified intensivists (88% vs 60%, p<0.001) when compared to high FTR hospitals. There was also significantly more staffing of low FTR hospitals by hospitalists (85 vs 20%, p<0.001) and residents (62 vs 40%, p<0.01). Low FTR hospitals were noted to have more overnight coverage using APP (75% vs 45%, p<0.001) as well as a dedicated RRT (90% vs 60%, p<0.001).
Conclusion: Low FTR hospitals had significantly more staffing resources than high FTR hospitals. While hiring additional staff may be beneficial, there remain significant financial limitations for many hospitals to implement robust staffing models. As such, our ongoing work seeks to improve rescue rates with better understanding and implementation of effective hospital staffing strategies within these constraints.
