From the Michael E. DeBakey Department of Surgery (J.I.P., S.R.S., N.N.M.) the Department of Medicine (H.S.), Baylor College of Medicine, Houston, Texas the Division of Pediatric Surgery, Texas Children's Hospital, Houston, Texas (S.R.S.) the Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center (H.S., N.N.M.), Houston, Texas.
Anesthesiology. 2019 Aug;131(2):426-437. doi: 10.1097/ALN.0000000000002602.
Over the past decade, failure to rescue-defined as the death of a patient after one or more potentially treatable complications-has received increased attention as a surgical quality indicator. Failure to rescue is an appealing quality target because it implicitly accounts for the fact that postoperative complications may not always be preventable and is based on the premise that prompt recognition and treatment of complications is a critical, actionable point during a patient's postoperative course. Although numerous patient and macrosystem factors have been associated with failure to rescue, there is an increasing appreciation of the key role of microsystem factors. Although failure to rescue is believed to contribute to observed hospital-level variation in both surgical outcomes and costs, further work is needed to delineate the underlying patient-level and system-level factors preventing the timely identification and treatment of postoperative complications. Therefore, the goals of this narrative review are to provide a conceptual framework for understanding failure to rescue, to discuss various associated patient- and system-level factors, to delineate the reasons it has become recognized as an important quality indicator, and to propose future directions of scientific inquiry for developing effective interventions that can be broadly implemented to improve postoperative outcomes across all hospitals.
在过去的十年中，作为手术质量指标，未能抢救（定义为患者在出现一种或多种潜在可治疗并发症后死亡）受到了越来越多的关注。未能抢救是一个有吸引力的质量目标，因为它隐含地考虑到术后并发症并非总是可以预防的这一事实，并且基于这样一个前提，即及时识别和治疗并发症是患者术后过程中的一个关键、可操作的点。尽管有许多患者和宏观系统因素与未能抢救相关，但人们越来越认识到微观系统因素的关键作用。尽管人们认为未能抢救导致了观察到的医院层面在手术结果和成本方面的差异，但仍需要进一步的工作来阐明潜在的患者层面和系统层面因素，以防止及时识别和治疗术后并发症。因此，本叙述性综述的目的是提供一个理解未能抢救的概念框架，讨论各种相关的患者和系统层面因素，阐明它为何被认为是一个重要的质量指标，并提出未来科学研究的方向，以制定可以广泛实施的有效干预措施，改善所有医院的术后结果。
