Failure to Rescue

Validation of an Algorithm Using Administrative Data

Failure to rescue (FTR) is an algorithm refined by the Agency for Healthcare Research and Quality (AHRQ) for broad distribution which indicates the rate of death among patients who developed one of six in-hospital complications. It is used in publicly reported safety ratings for individual hospitals and hospital-level quality improvement initiatives. Researchers in this study reviewed charts in 60 cases of FTR identified by the algorithm at each of 40 University HealthSystem Consortium institutions in order to assess overall accuracy. They found that the patient safety measure misidentifies half of the cases on average, is least accurate for nonsurgical cases, is widely variable across institutions, and is better for patients who have died than those who survived.

Since the FTR algorithm uses administrative data which are collected primarily for billing purposes, it is not easy to distinguish complications from previous conditions. The authors conclude that this indicator may be useful internally to flag possible cases of quality failure, but has limitations for external institutional comparisons. Improvements in coding quality and consistency across institutions would substantially improve its usefulness.

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