Concept Architecture
Concept
Theoretically, Failure to Rescue (FTR) is a healthcare quality and patient safety measure that quantifies mortality among patients who develop treatable complications during hospital care. Rather than measuring the occurrence of complications themselves, it evaluates a healthcare system's ability to recognise, respond to and successfully manage those complications before death occurs. The concept is grounded in healthcare quality measurement and outcomes research and exists to distinguish the quality of clinical response from the underlying risk of complications.
Mathematically, Failure to Rescue is represented as the proportion of patients who die after experiencing one or more qualifying complications. It is expressed as a conditional probability, with the denominator restricted to patients who develop complications. This standardisation allows comparisons of rescue performance between healthcare providers while accounting for differing complication rates.
In practice, Failure to Rescue is calculated using routinely collected hospital administrative or clinical registry data. Patients with predefined complications are identified, and deaths occurring within this cohort are counted to estimate the Failure to Rescue rate. The measure is widely used for hospital benchmarking, surgical quality assessment, patient safety monitoring and health services research.
Purpose
Used to evaluate the effectiveness of recognising and managing serious complications, benchmark hospital quality, monitor patient safety, assess surgical performance and support healthcare quality improvement initiatives.
Mathematical Formulae
Primary Formula
Failure to Rescue Rate = Number of Deaths Following Complications � Number of Patients with Complications
Supporting Formulae
Failure to Rescue Percentage = (Number of Deaths Following Complications � Number of Patients with Complications) ? 100
Related Mathematical Methods
- Conditional probability
- Incidence proportion
- Risk-adjusted mortality modelling
- Logistic regression
- Hierarchical modelling
- Risk standardisation
Example
A hospital treats 4,500 surgical patients during one year. Among these, 180 patients experience one or more qualifying postoperative complications. Twelve of these patients subsequently die.
Failure to Rescue Rate = 12 � 180
= 0.0667
Failure to Rescue Percentage = 0.0667 ? 100
= 6.67%
The hospital therefore has a Failure to Rescue rate of 6.67%, indicating that approximately seven patients die for every 100 patients who experience a major complication.
Excel Implementation
| Function | Example Formula | Health Economics Application |
|---|---|---|
| COUNTIFS | =COUNTIFS(B:B,"Complication",C:C,"Death") | Count deaths following qualifying complications. |
| COUNTIF | =COUNTIF(B:B,"Complication") | Count patients experiencing qualifying complications. |
| COUNTIFS/COUNTIF | =COUNTIFS(B:B,"Complication",C:C,"Death")/COUNTIF(B:B,"Complication") | Calculate the Failure to Rescue rate. |
| IF | =IF(D2>0.05,"Above Benchmark","Within Benchmark") | Compare organisational performance with quality targets. |
| AVERAGE | =AVERAGE(E2:E13) | Calculate the average monthly Failure to Rescue rate. |
VBA (Optional)
Automate calculation of Failure to Rescue rates across clinical specialties and reporting periods while generating quality and patient safety dashboards.
Sources
- Silber JH, Williams SV, Krakauer H, Schwartz JS. Hospital and Patient Characteristics Associated with Death after Surgery: A Study of Adverse Occurrence and Failure to Rescue. Medical Care.
- Agency for Healthcare Research and Quality. Patient Safety Indicators Technical Specifications.
- OECD. Health Care Quality Indicators Project.
- Drummond MF, Sculpher MJ, Claxton K, Stoddart GL, Torrance GW. Methods for the Economic Evaluation of Health Care Programmes.
- Briggs A, Claxton K, Sculpher M. Decision Modelling for Health Economic Evaluation.
Related Concepts (2)
Library
Publications
1
The World Health Report 2000 — Health Systems: Improving Performance — World Health Organization, 2000 Edition ed., 2000 (World Health Organization)
The landmark WHO report that introduced a framework for assessing and ranking health-system performance across goals of health, responsiveness and fairness in financing — hugely influential (and much debated) in launching the field of health-system performance assessment.
Frequently Asked Questions (6)
What is failure to rescue?
A measure of the rate at which patients with a serious post-surgical complication subsequently die, indicating a hospital's ability to respond effectively.
Source: Silber, Williams, Krakauer & Schwartz 1992
What does failure to rescue measure?
Failure to rescue measures the rate at which patients with a serious post-surgical complication subsequently die, so it captures how often a serious complication after surgery leads to death, indicating a hospital's ability to respond effectively. This rate of death after complication defines it. So failure to rescue is a measure of the rate at which patients with a serious post-surgical complication subsequently die, indicating a hospital's ability to respond effectively.
Source: Silber, Williams, Krakauer & Schwartz 1992
What does failure to rescue indicate about a hospital?
Failure to rescue indicates a hospital's ability to respond effectively, so the rate at which patients with a serious post-surgical complication subsequently die reflects how well the hospital rescues patients once a complication occurs. This indication of responsiveness is its purpose. So failure to rescue indicates a hospital's ability to respond effectively, measuring the rate at which patients with a serious post-surgical complication subsequently die This patient group is what the measure is built around, since it looks only at those who develop a complication.
Source: Silber, Williams, Krakauer & Schwartz 1992
Which patients does failure to rescue concern?
Failure to rescue concerns patients with a serious post-surgical complication, so it looks at those who develop a serious complication after surgery and measures the rate at which they subsequently die. This patient group defines the measure. So failure to rescue concerns patients with a serious post-surgical complication, measuring the rate at which they subsequently die and indicating a hospital's ability to respond effectively This focus on rescue is what makes the measure a signal of responsiveness rather than of how often complications occur.
Source: Silber, Williams, Krakauer & Schwartz 1992
Why is failure to rescue a measure of response rather than complications?
Failure to rescue measures response rather than complications because it looks at deaths among patients who already have a serious post-surgical complication, so it reflects how effectively the hospital responds once a complication has occurred rather than how often complications arise. This focus on rescue defines it. So failure to rescue measures the rate at which patients with a serious post-surgical complication subsequently die, indicating a hospital's ability to respond effectively.
Source: Silber, Williams, Krakauer & Schwartz 1992
How does failure to rescue relate to a complication measure?
Failure to rescue relates to a complication measure as a distinct but connected indicator: a complication measure tracks the frequency of specific adverse outcomes, while failure to rescue tracks deaths among patients who already have a serious complication. So a complication measure counts complications and failure to rescue counts the deaths that follow them, connected as measures reflecting different stages of post-surgical harm This division reflects that the two measures capture different stages of harm after surgery.
Source: Silber, Williams, Krakauer & Schwartz 1992
Trust Record
Verified by Dr Darrin Baines
British health economist
Professional identity: darrinbaines.org
Verification date: 26 Feb 2026
Content version: 1.0.0
Canonical Identity
- Persistent URI
- https://healtheconomics.wiki/concept/failure-to-rescue
- Term code
- HS-HP-HQ-012
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