The use of failure to rescue (FTR) as a quality metric provides important information about pediatric congenital cardiac catheterization laboratory programs and should be included in future research and quality improvement efforts, according to a study published Oct. 17 in the Journal of the American Heart Association.

Using data from ACC's IMPACT Registry, Michael L. O'Bryne, MD, MSCE, et al., developed a modified FTR metric for the pediatric cardiac cath lab environment and then assessed what patient-, procedure- and hospital-level factors were associated with risk of complications and FTR. The researchers also looked at whether there was a correlation between hospital rankings based on FTR and pooled adverse events (AEs). FTR was defined as all deaths occurring within two days of catherization and all AEs that required care beyond the capacity of the cath lab. For all hospitals, the researchers also calculated ratios of observed to expected events for FTR, all AEs and catastrophic AEs for all hospitals.

Overall, the researchers studied 77,850 cath procedures in 53,056 patients with a median age of 4. Of the 91 hospitals, 46 percent were university or teaching hospitals, and 10 percent reported that a high proportion of cath lab patients were adults.

According to the results, the adjusted risk of FTR was lower at higher-volume hospitals and at hospitals that performed a high proportion of adult cases. Composite AEs were not significantly associated with hospital volume, but there was a significant association with patient-level and procedure-level factors. In addition, there was no correlation between hospital rankings by risk standardized ratios for all AEs or for FTR.

The findings "suggest that FTR provides information about hospital performance not captured by case-mix adjusted AE," the researchers write. They conclude that "FTR should be included along with pooled AEs in future research and quality improvement efforts."

FTR "does have its place and can complement other existing metrics," Ralf J. Holzer, MD, MSc, FACC, writes in an accompanying editorial. He adds that the use of FTR as a quality metric could "be further enhanced by validating causality between proximal AE and catastrophic outcomes, through further studies."

Keywords: Quality Improvement, Benchmarking, Hospitals, High-Volume, Registries, Diagnosis-Related Groups, Hospitals, Teaching, Cardiac Catheterization, National Cardiovascular Data Registries, IMPACT Registry

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