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Br J Surg. 2016 Jan;103(2):e47-51. doi: 10.1002/bjs.10031. Epub 2015 Nov 30.

Importance of teamwork, communication and culture on failure-to-rescue in the elderly.

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Ann Arbor Veterans Administration Healthcare System, University of Michigan, Ann Arbor, Michigan, USA.
Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan, USA.
Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.



Surgical mortality increases significantly with age. Wide variations in mortality rates across hospitals suggest potential levers for improvement. Failure-to-rescue has been posited as a potential mechanism underlying these differences.


A review was undertaken of the literature evaluating surgery, mortality, failure-to-rescue and the elderly. This was followed by a review of ongoing studies and unpublished work aiming to understand better the mechanisms underlying variations in surgical mortality in elderly patients.


Multiple hospital macro-system factors, such as nurse staffing, available hospital technology and teaching status, are associated with differences in failure-to-rescue rates. There is emerging literature regarding important micro-system factors associated with failure-to-rescue. These are grouped into three broad categories: hospital resources, attitudes and behaviours. Ongoing work to produce interventions to reduce variations in failure-to-rescue rates include a focus on teamwork, communication and safety culture. Researchers are using novel mixed-methods approaches and theories adapted from organizational studies in high-reliability organizations in an effort to improve the care of elderly surgical patients.


Although elderly surgical patients experience failure-to-rescue events at much higher rates than their younger counterparts, patient-level effects do not sufficiently explain these differences. Increased attention to the role of organizational dynamics in hospitals' ability to rescue these high-risk patients will establish high-yield interventions aimed at improving patient safety.

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