title: Importance of teamwork, communication and culture on failure-to-rescue in the elderly.
abstract: BACKGROUND
  Surgical mortality increases significantly with age. Wide variations in mortality rates across hospitals suggest potential levers for improvement. Failure-to-rescue has been posited as a potential mechanism underlying these differences.
  
  
  METHODS
  A review was undertaken of the literature evaluating surgery, mortality, failure-to-rescue and the elderly. This was followed by a review of ongoing studies and unpublished work aiming to understand better the mechanisms underlying variations in surgical mortality in elderly patients.
  
  
  RESULTS
  Multiple hospital macro-system factors, such as nurse staffing, available hospital technology and teaching status, are associated with differences in failure-to-rescue rates. There is emerging literature regarding important micro-system factors associated with failure-to-rescue. These are grouped into three broad categories: hospital resources, attitudes and behaviours. Ongoing work to produce interventions to reduce variations in failure-to-rescue rates include a focus on teamwork, communication and safety culture. Researchers are using novel mixed-methods approaches and theories adapted from organizational studies in high-reliability organizations in an effort to improve the care of elderly surgical patients.
  
  
  CONCLUSIONS
  Although elderly surgical patients experience failure-to-rescue events at much higher rates than their younger counterparts, patient-level effects do not sufficiently explain these differences. Increased attention to the role of organizational dynamics in hospitals' ability to rescue these high-risk patients will establish high-yield interventions aimed at improving patient safety.
authors.affiliation: Ann Arbor Veterans Administration Healthcare System, University of Michigan, Ann Arbor, Michigan, USA.|Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan, USA.|Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: A A
authors.initials: AA
authors.lastname: Ghaferi
authors.affiliation: Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan, USA.|Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: J B
authors.initials: JB
authors.lastname: Dimick
mesh_terms: D000368:Aged; D002983:Clinical Competence / Q000592:standards; D003142:Communication; D003695:Delivery of Health Care / Q000592:standards; D000067248:Failure to Rescue, Health Care / Q000706:statistics & numerical data*; D005544:Forecasting; D006801:Humans; D007400:Interprofessional Relations; D010348:Patient Care Team / Q000458:organization & administration / Q000592:standards*; D058996:Quality Improvement; D013514:Surgical Procedures, Operative / Q000401:mortality*