OBJECTIVE: To identify hospital staffing models associated with failure to rescue (FTR) rates at low- and high-performing hospitals. BACKGROUND: FTR is an important quality measure in surgical safety and is a metric that hospitals are seeking to improve. Specific unit-level determinants of FTR, however, remain unknown. METHODS: Retrospective, observational study using data from the Michigan Quality Surgical Collaborative, which is a prospectively collected and clinically audited database in the state of Michigan. We identified 44,567 patients undergoing major general or vascular surgery from 2008 to 2012. Our main outcome measures were mortality, complications, and FTR rates. RESULTS: Hospital rates of FTR across low, middle, and high tertiles were 8.9%, 16.5%, and 19.9%, respectively (P < 0.001). Low FTR hospitals tended to have a closed intensive care unit staffing model (56% vs 20%, P < 0.001) and a higher proportion of board-certified intensivists (88% vs 60%, P < 0.001) when compared to high FTR hospitals. There was also significantly more staffing of low FTR hospitals by hospitalists (85% vs 20%, P < 0.001) and residents (62% vs 40%, P < 0.01). Low FTR hospitals were noted to have more overnight coverage (75% vs 45%, P < 0.001) as well as a dedicated rapid response team (90% vs 60%, P < 0.001). CONCLUSIONS: Low FTR hospitals had significantly more staffing resources than high FTR hospitals. Although hiring additional staff may be beneficial, there remain significant financial limitations for many hospitals to implement robust staffing models. Thus, our ongoing work seeks to improve rescue and implement effective staffing strategies within these constraints.
OBJECTIVE: To identify hospital staffing models associated with failure to rescue (FTR) rates at low- and high-performing hospitals. BACKGROUND: FTR is an important quality measure in surgical safety and is a metric that hospitals are seeking to improve. Specific unit-level determinants of FTR, however, remain unknown. METHODS: Retrospective, observational study using data from the Michigan Quality Surgical Collaborative, which is a prospectively collected and clinically audited database in the state of Michigan. We identified 44,567 patients undergoing major general or vascular surgery from 2008 to 2012. Our main outcome measures were mortality, complications, and FTR rates. RESULTS: Hospital rates of FTR across low, middle, and high tertiles were 8.9%, 16.5%, and 19.9%, respectively (P < 0.001). Low FTR hospitals tended to have a closed intensive care unit staffing model (56% vs 20%, P < 0.001) and a higher proportion of board-certified intensivists (88% vs 60%, P < 0.001) when compared to high FTR hospitals. There was also significantly more staffing of low FTR hospitals by hospitalists (85% vs 20%, P < 0.001) and residents (62% vs 40%, P < 0.01). Low FTR hospitals were noted to have more overnight coverage (75% vs 45%, P < 0.001) as well as a dedicated rapid response team (90% vs 60%, P < 0.001). CONCLUSIONS: Low FTR hospitals had significantly more staffing resources than high FTR hospitals. Although hiring additional staff may be beneficial, there remain significant financial limitations for many hospitals to implement robust staffing models. Thus, our ongoing work seeks to improve rescue and implement effective staffing strategies within these constraints.
Authors: Vicente H Gracias; Corinna P Sicoutris; S Peter Stawicki; Denise M Meredith; Annamarie D Horan; Rajan Gupta; Elliott R Haut; Sue Auerbach; Seema Sonnad; C William Hanson; C William Schwab Journal: J Nurs Care Qual Date: 2008 Oct-Dec Impact factor: 1.597
Authors: Peter J Pronovost; Derek C Angus; Todd Dorman; Karen A Robinson; Tony T Dremsizov; Tammy L Young Journal: JAMA Date: 2002-11-06 Impact factor: 56.272
Authors: Elliot Wakeam; Nathanael D Hevelone; Rebecca Maine; Jabaris Swain; Stuart A Lipsitz; Samuel R G Finlayson; Stanley W Ashley; Joel S Weissman Journal: JAMA Surg Date: 2014-03 Impact factor: 14.766
Authors: Paul S Chan; Adnan Khalid; Lance S Longmore; Robert A Berg; Mikhail Kosiborod; John A Spertus Journal: JAMA Date: 2008-12-03 Impact factor: 56.272
Authors: Calista M Harbaugh; Michael N Terjimanian; Jay S Lee; Abbas Z Alawieh; Daniel B Kowalsky; Lindsay M Tishberg; Robert W Krell; Sven A Holcombe; Stewart C Wang; Darrell A Campbell; Michael J Englesbe Journal: Ann Surg Date: 2013-04 Impact factor: 12.969
Authors: Margaret E Smith; Emily E Wells; Christopher R Friese; Sarah L Krein; Amir A Ghaferi Journal: Health Aff (Millwood) Date: 2018-11 Impact factor: 6.301
Authors: Michael J Pienta; Xiaoting Wu; Thomas M Cascino; Alexander A Brescia; Ashraf Abou El Ela; Min Zhang; Jeffrey S McCullough; Supriya Shore; Keith D Aaronson; Michael P Thompson; Francis D Pagani; Donald S Likosky Journal: Ann Thorac Surg Date: 2022-02-15 Impact factor: 5.102
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
Authors: Donald S Likosky; Raymond J Strobel; Xiaoting Wu; Robert S Kramer; Baron L Hamman; James K Brevig; Michael P Thompson; Amir A Ghaferi; Min Zhang; Eric J Lehr Journal: J Thorac Cardiovasc Surg Date: 2021-01-29 Impact factor: 6.439
Authors: Kristiina Kyrklund; Cornelius E J Sloots; Ivo de Blaauw; Kristin Bjørnland; Udo Rolle; Duccio Cavalieri; Paola Francalanci; Fabio Fusaro; Annette Lemli; Nicole Schwarzer; Francesco Fascetti-Leon; Nikhil Thapar; Lars Søndergaard Johansen; Dominique Berrebi; Jean-Pierre Hugot; Célia Crétolle; Alice S Brooks; Robert M Hofstra; Tomas Wester; Mikko P Pakarinen Journal: Orphanet J Rare Dis Date: 2020-06-25 Impact factor: 4.123