Importance of teamwork, communication and culture on failure-to-rescue in the elderly

Br J Surg. 2016 Jan;103(2):e47-51. doi: 10.1002/bjs.10031. Epub 2015 Nov 30.


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 This was followed by a review of ongoing studies and unpublished work aiming to understand better the mechanisms underlying variations in surgical mortality in elderly patients.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.

Conclusion: 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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Aged
  • Clinical Competence / standards
  • Communication
  • Delivery of Health Care / standards
  • Failure to Rescue, Health Care / statistics & numerical data*
  • Forecasting
  • Humans
  • Interprofessional Relations
  • Patient Care Team / organization & administration
  • Patient Care Team / standards*
  • Quality Improvement
  • Surgical Procedures, Operative / mortality*