title: Hospital characteristics associated with failure to rescue from complications after pancreatectomy.
abstract: BACKGROUND
  Failure to rescue (ie, mortality after a major complication) has recently been demonstrated as a mechanism underlying differences between high and low mortality hospitals. In this study, we sought to better understand the hospital characteristics that may explain failure to rescue.
  
  
  METHODS
  Using data from the 2000 to 2006 Nationwide Inpatient Sample and the American Hospital Association annual survey, we evaluated the effect of 5 hospital level characteristics on failure to rescue (FTR) rates. Using multivariate logistic regression models, we determined the relative contribution of each of these factors to the FTR rates at the lowest and highest mortality hospitals.
  
  
  RESULTS
  Failure to rescue varied 6-fold across hospitals (6.4% in very low mortality hospitals vs 40.0% in very high mortality hospitals, p < 0.001). Several hospital characteristics were significantly associated with lower FTR: teaching status (odds ratio [OR] 0.66, 95% CI 0.53 to 0.82), hospital size greater than 200 beds (OR 0.65, 95% CI 0.48 to 0.87), average daily census greater than 50% capacity (OR 0.56, 95%CI 0.32 to 0.98), increased nurse-to-patient ratios (OR 0.94, 95% CI 0.89 to 0.99), and high hospital technology (OR 0.65, 95% CI 0.52 to 0.81). Including all hospital characteristics into a multivariate model results in a 36% reduction in the odds of FTR between very high and very low mortality hospitals (OR 6.6, 95% CI 3.7 to 11.9).
  
  
  CONCLUSIONS
  Several hospital characteristics are associated with FTR from major complications. However, a large portion of what makes some hospitals better than others at rescuing patients remains unexplained. Future research should focus on hospital cultures and attitudes that may contribute to the timely recognition and effective management of major complications.
authors.affiliation: Michigan Surgical Collaborative for Outcomes Research and Evaluation (M-SCORE), Department of Surgery, University of Michigan, Ann Arbor, MI, USA. aghaferi@umich.edu
authors.forename: Amir A
authors.initials: AA
authors.lastname: Ghaferi
authors.forename: Nicholas H
authors.initials: NH
authors.lastname: Osborne
authors.forename: John D
authors.initials: JD
authors.lastname: Birkmeyer
authors.forename: Justin B
authors.initials: JB
authors.lastname: Dimick
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D015897:Comorbidity; D016001:Confidence Intervals; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006761:Hospitals / Q000592:standards* / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D015999:Multivariate Analysis; D009726:Nurses / Q000706:statistics & numerical data*; D016017:Odds Ratio; D010180:Pancreatectomy / Q000009:adverse effects* / Q000401:mortality; D010561:Personnel Staffing and Scheduling / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality*; D012307:Risk Factors; D012737:Sex Factors; D017211:Treatment Failure; D014481:United States / Q000453:epidemiology