Causes of Failure to Rescue

Abstract

Failure to rescue (FTR) is death due to a complication in hospitalized patients. Although complications have varied causation, the common end manifestation prior to death is the development of physiologic instability manifested by abnormalities in vital signs evolving to compromise of end-organ perfusion and metabolic derangement due to tissue hypoperfusion. In order to prevent FTR, instability must first be detected by clinicians and then recognized as important before supportive or rescue action can be initiated. This chapter explores factors which contribute to FTR. They include patient-level factors (static and dynamic patient data and surveillance) and hospital- and system-level factors (staff education, staff-level and temporal variation, lack of consistent clinician exposure to instability, lack of situation and human factors awareness, barriers to care escalation). Understanding the complexity of the interrelationships impacting FTR may assist in developing and implementing interventions to improve clinician's ability to utilize medical emergency team resources and decrease FTR.