Learning Objective #1: Define the concept of failure to rescue

Learning Objective #2: Describe the relationship of unit characteristics and failure to rescue

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There are two large studies that link failure to rescue with nurse staffing. Needleman, Buerhaus, Mattke, Stewart, and Zelevinsky (2002) measured nurse-staffing levels with mortality and failure to rescue. In a large multi-state study, they found that among medical patients, a higher proportion of hours of care provided by registered nurses were associated with lower rates of failure to rescue. Among surgical patients, a greater number of hours of care per day provided by registered nurses were associated with lower rates of failure to rescue. Aiken, Clarke, Sloane, Sochalski, & Silber (2002) measured patient to nurse ratio and failure to rescue among surgical patients in Pennsylvania hospitals. They found that each additional patient per nurse increased the odds of failure to rescue by 7%. A major limitation of these studies was the use of administrative data bases in determining failure-to-rescue cases. These data bases are ICD-9 discharge diagnosis codes that are reported statewide on Medicare patients. Discharge diagnoses do not reflect the morbidities that are present on admission. Aiken, et al suggested that smaller studies using direct patient information be conducted to further investigate these relationships. The study being presented is being done at an acute care medical center. All patients who die within 30 days of admission receive a chart review. Each case is determined to be a failure or not, based on defined components. RN staffing and staffing mix on the day of the failure is then compared to the average RN staffing and staffing mix for that unit within a 30 day period of the failure. Data collection will be completed and analyzed by January 31, 2005. At the time of this submission, information regarding data analysis, results, and directions for future research are not yet available.