Failure-to-Rescue Rate as a Measure of Quality of Care in a Cardiac Surgery Recovery Unit: A Five-Year Study
Failure-to-Rescue Rate as a Measure of Quality of Care in a Cardiac Surgery Recovery Unit: A Five-Year Study
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DOI：
10.1016/j.athoracsur.2013.07.097
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发表时间：
2014-01-01
影响因子：
4.6
通讯作者：
Novick, Richard J.
中科院分区：
文献类型：
--
作者：
Ahmed, Elnazeer O.;Butler, Ron;Novick, Richard J.
背景抢救失败定义为入院时不存在的并发症后死亡的概率，于20世纪90年代作为一项质量指标引入，以补充死亡率和发病率结局。本研究的目的是评估衡量心脏手术后抢救失败的可能增量效益，以促进质量改进工作。前瞻性地收集了在5年期间接受心脏手术的4，978例连续患者的数据。使用机构逻辑回归模型来生成死亡率和主要并发症的预测率。确定发病率的频率分布，并计算抢救失败率。采用卡方检验对比每年抢救失败率，并与发病率和死亡率进行比较。总死亡率为3.6%，总并发症发生率为16.8%，抢救失败率为19.8%（95%置信区间，17.1%至22.7%）。在研究的最后2年，死亡率和主要并发症的预测风险增加，而观察到的并发症发生率下降。新发肾功能衰竭抢救失败率最高（48.4%），其次为败血症（42.6%）。尽管研究结束时并发症发生率降低，但抢救失败率没有显著变化（p = 0.28）。除了死亡率和并发症发生率外，应将抢救失败作为护理质量指标进行监测。术后肾功能衰竭和败血症仍然有很高的抢救失败率，应该通过质量改进工作的目标。(C)2014年由胸外科医师协会
Background. Failure to rescue, which is defined as the probability of death after a complication that was not present on admission, was introduced as a quality measure in the 1990s, to complement mortality and morbidity outcomes. The objective of this study was to evaluate possible incremental benefits of measuring failure to rescue after cardiac surgery, to facilitate quality improvement efforts.Methods. Data were collected prospectively on 4,978 consecutive patients who underwent cardiac operations during a 5-year period. Institutional logistic regression models were used to generate predicted rates of mortality and major complications. Frequency distributions of morbidities were determined, and failure to rescue was calculated. The annual failure-to-rescue rates were contrasted using chi(2) tests and compared with morbidity and mortality measures.Results. The overall mortality rate was 3.6%, the total complication rate was 16.8%, and the failure-to-rescue rate was 19.8% (95% confidence interval, 17.1% to 22.7%). The predicted risk of mortality and of major complications increased during the last 2 years of the study, whereas the observed complication rate decreased. Failure to rescue for new renal failure was the highest of all complications (48.4%), followed by septicemia (42.6%). Despite the decreased complication rate toward the end of the study, the failure-to-rescue rate did not change significantly (p = 0.28).Conclusions. Failure to rescue should be monitored as a quality-of-care metric, in addition to mortality and complication rates. Postoperative renal failure and septicemia still have a high failure-to-rescue rate and should be targeted by quality improvement efforts. (C) 2014 by The Society of Thoracic Surgeons