Failure to rescue refers to delayed or missed recognition of a potentially fatal complication that results in a patient’s death. This single-center study sought to more effectively manage deteriorating patients after emergency surgery and reduce failure to rescue rates. Researchers used the functional resonance analysis method (FRAM) to develop recommendations for strengthening organizational resilience. Recommendations included improving team communication, organizational learning, and relationships.

This interview study examined escalation of care, the process by which a patient's deteriorating clinical status is recognized and acted upon, among surgical patients. Attending surgeons, trainees, intensivists, and rapid response team members believe that protocols for escalation of care lack clarity and that there is a dearth of supervision from senior clinicians. Similar to studies of handoffs, direct conversation—either in person or via mobile phone—was deemed preferable to hospital paging systems. Participants identified communication training, explicit and clear protocols, and increased supervision as key to improving the care of deteriorating surgical patients. Accompanying editorials highlight the importance of communication and the need for a safety culture that supports multidisciplinary teams.

This systematic review was unable to estimate the incidence and preventability rate of adverse events that precipitate intensive care unit admission due to study heterogeneity. The authors discuss the recommended prevention strategies, including rapid response systems, but also raise concerns about the limited evidence surrounding these strategies.

Rapid response systems function within a variety of structures, but they ultimately remain a mechanism to manage a clinically deteriorating patient. This prospective study demonstrated that implementation of an intensivist physician and nurse–based team led to improvements in cardiac arrest rates and adjusted hospital mortality.

This study conducted telephone questionnaires of trainees and discovered several areas for improvement in handoff communications.