The Agency for Healthcare Research and Quality (AHRQ) patient safety indicator "death among surgical inpatients with serious treatable complications" (or failure-to-rescue) uses rules to exclude complications thought to be present-on-admission (POA). However, exclusion rules were developed with limited information on whether complications were POA. This study examines whether the accuracy of failure-to-rescue exclusion rules can be improved with data with good POA indicators.
Led by scholars in nursing and health services research and informatics, the goal of this interdisciplinary team was to refine one of the most controversial measures of nursing-sensitive quality of care: failure to rescue. Refinement of this measure is expected to result in a measure of the quality of nursing care that is more likely to be used for quality improvement, public accountability, and pay for performance.
Reports that medical errors account for substantial in-hospital mortality are difficult to substantiate due to the challenges of identifying hospital-acquired conditions using claims data. In most cases, discharge diagnosis codes are used to identify suspect conditions and exclusion rules are then applied to distinguish hospital-acquired conditions from those present when the patient was admitted. No estimates are available of hospital-acquired complications that are missed using claims-based approaches.