Variation in hospital complication rates and failure-to-rescue for trauma patients.

OBJECTIVE: To examine whether failure-to-rescue is an important mechanism driving outcome differences across low- and high-mortality hospitals caring for trauma patients.
BACKGROUND: Reducing medical errors and complications has become the focus of quality improvement efforts. Patients undergoing general and vascular surgery in high-mortality hospitals have similar rates of complications but higher failure-to-rescue rates compared to patients in low-mortality hospitals.
METHODS: Retrospective cohort study based on 54,713 patient records in the National Trauma Databank in 2007. Hospitals were classified as low-mortality, average, and high-mortality hospitals using the Trauma Mortality Probability Model. Regression modeling was used to explore the impact of hospital quality ranking on the incidence of major complications and on the incidence of failure-to-rescue (death after a major complication), adjusting for injury severity, mechanism of trauma, and patient physiology.
RESULTS: Trauma patients in low-mortality hospitals had similar unadjusted rates of major complications compared to patients in high-mortality hospitals (5.9% vs. 5.5%). However, patients in low-mortality hospital had a lower failure-to-rescue rate compared to patients in high-mortality hospitals (adj OR 0.26: 95% CI 0.20, 0.39)
CONCLUSION: Our findings suggest that the primary driver of differences in hospital quality for trauma patients is failure-to-rescue as opposed to differences in complication rates. Achieving lower mortality rates in trauma patients may require reducing both the incidence of major complications and the incidence of death after major complications.