Failure to rescue: How this quality metric is transforming patient safety

In today’s evolving landscape of healthcare quality measurement, failure to rescue (FTR) has become a critical benchmark for hospital performance. First introduced in 1992 by Jeffrey H. Silber, FTR has grown from an academic concept into a widely adopted quality metric, influencing research, policy and reimbursement models.

Explore key insights from Solventum expert Teresa Brown, RN, CCDS, CCDS-O, CDIP, CCS, in her JustCoding.com piece, Tracing the origins of failure to rescue: From mortality rates to system response, to learn why FTR matters for healthcare professionals, especially those in coding and clinical documentation integrity (CDI).
 

What is failure to rescue and why it matters 

FTR measures a hospital’s ability to prevent death after a treatable complication occurs. Unlike complication rates, which show how often problems arise, FTR evaluates how effectively a system responds when those problems happen. This makes FTR a powerful lens for assessing patient safety and care quality.
 

The origins of FTR: From mortality to system response 

Before FTR, quality metrics focused on mortality and complication rates. Researchers noticed inconsistencies: hospitals with high complication rates sometimes had low mortality, while others with fewer complications had higher mortality. Silber’s 1992 study introduced FTR to capture this missing piece — system responsiveness.
 

How FTR became a standard quality measure 

Over time, FTR evolved through:

• Refined definitions: Focus on serious, treatable complications like sepsis and pneumonia.
• Risk adjustment: Incorporating patient age, comorbidities, and illness severity.
• Nursing-sensitive metrics: Linking nurse staffing and work environment to FTR outcomes.
• Better data sources: Moving from claims data to clinical registries for accuracy. 
   

FTR and its impact on coding and CDI 

Starting FY 2027, the Centers for Medicare and Medicaid Services (CMS) will replace PSI 04 with FTR in its Inpatient Prospective Payment System (IPPS). Leapfrog’s Hospital Safety Grade will also adopt FTR in Spring 2027. For coding and CDI professionals, accurate documentation is essential — FTR rates directly affect hospital evaluations and reimbursement.
 

Looking ahead: CMS and Leapfrog adoption 

FTR is more than a statistic; it’s a tool for improvement. By focusing on rescue after complications, hospitals can identify gaps and enhance patient safety. Read the full article on JustCoding.com for an in-depth look at FTR’s history and methodology.

Teresa Brown, RN, CCDS, CCDS-O, CDIP, CCS, is a clinical analyst at Solventum.