Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Best Pract Res Clin Anaesthesiol. 2021 Dec;35(4):575-589. doi: 10.1016/j.bpa.2020.09.003. Epub 2020 Sep 25.
Postoperative complications occur despite optimal perioperative care and are an important driver of mortality after surgery. Failure to rescue, defined as death in a patient who has experienced serious complications, has emerged as a quality metric that provides a mechanistic pathway to explain disparities in mortality rates among hospitals that have similar perioperative complication rates. The risk of failure to rescue is higher after invasive surgical procedures and varies according to the type of postoperative complication. Multiple patient factors have been associated with failure to rescue. However, failure to rescue is more strongly correlated with hospital factors. In addition, microsystem factors, such as institutional safety culture, teamwork, and other attitudes and behaviors may interact with the hospital resources to effectively prevent patient deterioration. Early recognition through bedside and remote monitoring is the first step toward prevention of failure to rescue followed by rapid response initiatives and timely escalation of care.
尽管进行了最佳的围手术期护理，术后并发症仍会发生，并且是手术后死亡的重要原因。未能抢救（定义为经历严重并发症的患者死亡）已成为一种质量指标，为解释具有相似围手术期并发症发生率的医院之间死亡率差异提供了一种机制途径。侵袭性手术程序后未能抢救的风险更高，并且根据术后并发症的类型而有所不同。多种患者因素与未能抢救有关。但是，未能抢救与医院因素的相关性更强。此外，微观系统因素，例如机构安全文化，团队合作以及其他态度和行为，可能与医院资源相互作用，以有效防止患者病情恶化。通过床边和远程监测进行早期识别是防止未能抢救的第一步，随后是快速反应措施和及时升级护理。
