title: The association of intensivists with failure-to-rescue rates in outlier hospitals: results of a national survey of intensive care unit organizational characteristics.
abstract: OBJECTIVE
  Critical care is often an integral part of rescue for patients with surgical complications. We sought to understand critical care characteristics predictive of failure-to-rescue (FTR) performance at the hospital level.
  
  
  METHODS
  Using 2009 to 2011 FTR data from Hospital Compare, we identified 144 outlier hospitals with significantly better/worse performance than the national average. We surveyed intensive care unit (ICU) directors and nurse managers regarding physical structures, patient composition, staffing, care protocols, and rapid response teams (RRTs). Hospitals were compared using descriptive statistics and logistic regression.
  
  
  RESULTS
  Of 67 hospitals completing the survey, 56.1% were low performing, and 43.9% were high performing. Responders were more likely to be teaching hospitals (40.9% vs 25.0%; P=.05) but were similar to nonresponders in terms of size, region, ownership, and FTR performance. Poor performers were more likely to serve higher proportions of Medicaid patients (68.4% vs 20.7%; P<.0001) and be level 1 trauma centers (55.9% vs 25.9%; P=.02). After controlling for these 2 characteristics, an intensivist on the RRT (adjusted odds ratio, 4.27; confidence interval, 1.45-23.02; P=.005) and an internist on staff in the ICU (adjusted odds ratio, 2.13; P=.04) were predictors of high performance.
  
  
  CONCLUSIONS
  Intensivists on the RRT and internists in the ICU may represent discrete organizational strategies for improving patient rescue. Hospitals with high Medicaid burden fare poorly on the FTR metric.
authors: Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA; Department of Surgery, University of Toronto, Toronto, Canada. Electronic address: ewakeam@partners.org.
authors: Elliot
authors: E
authors: Wakeam
authors: Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA.
authors: Denise
authors: D
authors: Asafu-Adjei
authors: Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA.
authors: Stanley W
authors: SW
authors: Ashley
authors: Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA.
authors: Zara
authors: Z
authors: Cooper
authors: Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA; Patient-Centered Comparative Effectiveness Research Center, Brigham and Women's Hospital, Boston, MA.
authors: Joel S
authors: JS
authors: Weissman
mesh_terms: D000368:Aged; D002985:Clinical Protocols; D016001:Confidence Intervals; D003422:Critical Care; D005260:Female; D006276:Health Facility Size / Q000592:standards / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006761:Hospitals / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration* / Q000592:standards; D016015:Logistic Models; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D008875:Middle Aged; D016017:Odds Ratio; D015279:Organizational Culture; D010561:Personnel Staffing and Scheduling; D011183:Postoperative Complications / Q000401:mortality*; D014481:United States
keywords: Critical care; Failure to rescue quality; Organizational behavior; Rapid response; Safety