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Is " failure to rescue" derived from administrative data in England a nurse sensitive patient safety indicator for surgical care? Observational study

Is " failure to rescue" derived from administrative data in England a nurse sensitive patient safety indicator for surgical care? Observational study
Is " failure to rescue" derived from administrative data in England a nurse sensitive patient safety indicator for surgical care? Observational study

Background: '. Failure to rescue' - death after a treatable complication - is used as a nursing sensitive quality indicator in the USA. It is associated with the size of the nursing workforce relative to patient load, for example patient to nurse ratio, although assessments of nurse sensitivity have not previously considered other staff groups. This study aims to assess the potential to derive failure to rescue and a proxy measure, based on long length of stay, from English hospital administrative data. By exploring change in coding practice over time and measuring associations between failure to rescue and factors including staffing, we assess whether two measures of failure to rescue are useful nurse sensitive indicators. Design: Cross sectional observational study of routinely collected administrative data. Participants: Discharge data from 66,100,672 surgical admissions to 146 general acute hospital trusts in England (1997-2009). Results: Median percentage of surgical admissions with at least one secondary diagnosis recorded increased from 26% in 1997/1998 to 40% in 2008/2009. Regression analyses showed that mortality based failure to rescue rates were significantly associated (p<0.05) with several hospital characteristics previously associated with quality, including staffing levels. Lower rates of failure to rescue were associated with a greater number of nurses per bed and doctors per bed in a bivariate analysis. Higher total clinically qualified staffing (doctors. +. nurses) per bed and a higher number of doctors relative to the number of nurses were both associated with lower mortality based failure to rescue in the fully adjusted analysis (p<0.05); however, the extended stay based measure showed the opposite relationship. Conclusion: Failure to rescue can be derived from English administrative data and may be a valid quality indicator. This is the first study to assess the association between failure to rescue and medical staffing. The suggestion that it is particularly sensitive to nursing is not clearly supported, nor is the suggestion that the number of patients with an extended hospital stay is a good proxy.

Health care, Hospital, Hospital mortality, Hospital staffing, Nursing care quality, Nursing Service, Nursing workforce, Operative/adverse effects, Quality indicators, Surgical procedures, Treatment failure
0020-7489
292-300
Griffiths, Peter
ac7afec1-7d72-4b83-b016-3a43e245265b
Jones, Simon
f5d66e16-2c8e-4d48-ab97-0715a6e85c46
Bottle, Alex
09c4f0e3-af73-4e49-9396-532c50f8d650
Griffiths, Peter
ac7afec1-7d72-4b83-b016-3a43e245265b
Jones, Simon
f5d66e16-2c8e-4d48-ab97-0715a6e85c46
Bottle, Alex
09c4f0e3-af73-4e49-9396-532c50f8d650

Griffiths, Peter, Jones, Simon and Bottle, Alex (2013) Is " failure to rescue" derived from administrative data in England a nurse sensitive patient safety indicator for surgical care? Observational study. International Journal of Nursing Studies, 50 (2), 292-300. (doi:10.1016/j.ijnurstu.2012.10.016).

Record type: Article

Abstract

Background: '. Failure to rescue' - death after a treatable complication - is used as a nursing sensitive quality indicator in the USA. It is associated with the size of the nursing workforce relative to patient load, for example patient to nurse ratio, although assessments of nurse sensitivity have not previously considered other staff groups. This study aims to assess the potential to derive failure to rescue and a proxy measure, based on long length of stay, from English hospital administrative data. By exploring change in coding practice over time and measuring associations between failure to rescue and factors including staffing, we assess whether two measures of failure to rescue are useful nurse sensitive indicators. Design: Cross sectional observational study of routinely collected administrative data. Participants: Discharge data from 66,100,672 surgical admissions to 146 general acute hospital trusts in England (1997-2009). Results: Median percentage of surgical admissions with at least one secondary diagnosis recorded increased from 26% in 1997/1998 to 40% in 2008/2009. Regression analyses showed that mortality based failure to rescue rates were significantly associated (p<0.05) with several hospital characteristics previously associated with quality, including staffing levels. Lower rates of failure to rescue were associated with a greater number of nurses per bed and doctors per bed in a bivariate analysis. Higher total clinically qualified staffing (doctors. +. nurses) per bed and a higher number of doctors relative to the number of nurses were both associated with lower mortality based failure to rescue in the fully adjusted analysis (p<0.05); however, the extended stay based measure showed the opposite relationship. Conclusion: Failure to rescue can be derived from English administrative data and may be a valid quality indicator. This is the first study to assess the association between failure to rescue and medical staffing. The suggestion that it is particularly sensitive to nursing is not clearly supported, nor is the suggestion that the number of patients with an extended hospital stay is a good proxy.

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Accepted/In Press date: 21 October 2012
Published date: 1 February 2013
Additional Information: Funding Information: PG conceived and designed the study jointly with SJ and AB. AB and SJ extracted data. AB and SJ mapped the AHRQ indicators to English coding and ICD 10 with advice from PG on clinical codes. SJ undertook statistical analysis and AB, PG and SJ interpreted the results. PG and SJ drafted the paper and AB, PG and SJ commented on drafts and approved the final version. SJ is guarantor for the extraction of data and analysis, PG for other aspects of the paper including the design, interpretation of results and decision to publish. Conflict of interest. None. Funding. This work was supported by the Policy Research Programme in the Department of Health in England, which commissioned this as an independent study [016/0058]. The views expressed are not necessarily those of the Department. The study was also supported in kind by the provision of data and time by the Dr Foster Unit of Imperial College and Dr Foster Intelligence. The Dr Foster Unit at Imperial is affiliated with the Imperial Centre for Patient Safety and Service Quality at Imperial College Healthcare NHS Trust, which is funded by the National Institute of Health Research. The Department of Primary Care and Social Medicine is grateful for support from the National Institute for Health Research Biomedical Research Centre Funding Scheme. Ethical approval. None.
Keywords: Health care, Hospital, Hospital mortality, Hospital staffing, Nursing care quality, Nursing Service, Nursing workforce, Operative/adverse effects, Quality indicators, Surgical procedures, Treatment failure
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 174071
URI: http://eprints.soton.ac.uk/id/eprint/174071
ISSN: 0020-7489
PURE UUID: 6196469b-34bc-4219-b86a-eaf247a62250
ORCID for Peter Griffiths: ORCID iD orcid.org/0000-0003-2439-2857

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Date deposited: 11 Feb 2011 11:22
Last modified: 04 Oct 2022 01:44

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Contributors

Author: Peter Griffiths ORCID iD
Author: Simon Jones
Author: Alex Bottle

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