Elliot Wakeam1, Denise Asafu-Adjei2, Stanley W Ashley2, Zara Cooper2, Joel S Weissman3. 1. Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA; Department of Surgery, University of Toronto, Toronto, Canada. Electronic address: ewakeam@partners.org. 2. Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA. 3. Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA; Patient-Centered Comparative Effectiveness Research Center, Brigham and Women's Hospital, Boston, MA.
Abstract
PURPOSE: Critical care is often an integral part of rescue for patients with surgical complications. We sought to understand critical care characteristics predictive of failure-to-rescue (FTR) performance at the hospital level. METHODS: Using 2009 to 2011 FTR data from Hospital Compare, we identified 144 outlier hospitals with significantly better/worse performance than the national average. We surveyed intensive care unit (ICU) directors and nurse managers regarding physical structures, patient composition, staffing, care protocols, and rapid response teams (RRTs). Hospitals were compared using descriptive statistics and logistic regression. RESULTS: Of 67 hospitals completing the survey, 56.1% were low performing, and 43.9% were high performing. Responders were more likely to be teaching hospitals (40.9% vs 25.0%; P=.05) but were similar to nonresponders in terms of size, region, ownership, and FTR performance. Poor performers were more likely to serve higher proportions of Medicaid patients (68.4% vs 20.7%; P<.0001) and be level 1 trauma centers (55.9% vs 25.9%; P=.02). After controlling for these 2 characteristics, an intensivist on the RRT (adjusted odds ratio, 4.27; confidence interval, 1.45-23.02; P=.005) and an internist on staff in the ICU (adjusted odds ratio, 2.13; P=.04) were predictors of high performance. CONCLUSIONS: Intensivists on the RRT and internists in the ICU may represent discrete organizational strategies for improving patient rescue. Hospitals with high Medicaid burden fare poorly on the FTR metric.
PURPOSE: Critical care is often an integral part of rescue for patients with surgical complications. We sought to understand critical care characteristics predictive of failure-to-rescue (FTR) performance at the hospital level. METHODS: Using 2009 to 2011 FTR data from Hospital Compare, we identified 144 outlier hospitals with significantly better/worse performance than the national average. We surveyed intensive care unit (ICU) directors and nurse managers regarding physical structures, patient composition, staffing, care protocols, and rapid response teams (RRTs). Hospitals were compared using descriptive statistics and logistic regression. RESULTS: Of 67 hospitals completing the survey, 56.1% were low performing, and 43.9% were high performing. Responders were more likely to be teaching hospitals (40.9% vs 25.0%; P=.05) but were similar to nonresponders in terms of size, region, ownership, and FTR performance. Poor performers were more likely to serve higher proportions of Medicaid patients (68.4% vs 20.7%; P<.0001) and be level 1 trauma centers (55.9% vs 25.9%; P=.02). After controlling for these 2 characteristics, an intensivist on the RRT (adjusted odds ratio, 4.27; confidence interval, 1.45-23.02; P=.005) and an internist on staff in the ICU (adjusted odds ratio, 2.13; P=.04) were predictors of high performance. CONCLUSIONS: Intensivists on the RRT and internists in the ICU may represent discrete organizational strategies for improving patient rescue. Hospitals with high Medicaid burden fare poorly on the FTR metric.
Authors: Jennifer J Chung; Emily C Earl-Royal; M Kit Delgado; Jose L Pascual; Patrick M Reilly; Douglas J Wiebe; Daniel N Holena Journal: Am Surg Date: 2017-03-01 Impact factor: 0.688
Authors: Rupen Shah; Kristopher Attwood; Shipra Arya; Daniel E Hall; Jason M Johanning; Emmanuel Gabriel; Anthony Visioni; Steven Nurkin; Moshim Kukar; Steven Hochwald; Nader N Massarweh Journal: JAMA Surg Date: 2018-05-16 Impact factor: 14.766
Authors: Justin S Hatchimonji; Elinore J Kaufman; Catherine E Sharoky; Lucy Ma; Anna E Garcia Whitlock; Daniel N Holena Journal: J Trauma Acute Care Surg Date: 2019-09 Impact factor: 3.313
Authors: Jennifer N Ervin; C Ann Vitous; Emily E Wells; Sarah L Krein; Christopher R Friese; Amir A Ghaferi Journal: Ann Surg Date: 2021-03-04 Impact factor: 13.787