CMS Will Soon Track Your Failure to Rescue Data—Are You Ready?

Are you tracking your hospital's failure to rescue rates? You'd better be, because CMS will—starting June 1.

Failure to rescue is defined as the percentage of major surgical inpatients who experience a hospital-acquired complication and die. And it's the first such nursing-sensitive performance measure on the list of 15 identified by the National Quality Forum in 2004 to be collected by CMS. It is also a red-flag indicator of how much time nurses are at the bedside. Nurses who spend a significant time in direct patient care—rather than in redundant paperwork for example—have been shown to prevent failure to rescue through early recognition of patients' clinical deterioration.

Studies—such as this recent one—show that nurses spend a significant amount of time in non-value added, non-patient care activities. An Institute of Medicine report in 2004 estimated RNs are only in patient rooms for 1.5 hours out of a 12-hour shift. The implications of this could have wide reaching ramification for hospitals once CMS starts analyzing and publically reporting failure to rescue data.

There are a number of high-profile initiatives—such as the IHI/RWJF-sponsored Transforming Care at the Bedside—that aim to remove some of the barriers that keep nurses away from the bedside and therefore improve quality of care.

VHA, Inc. is a national healthcare alliance of more than 1,400 not-for-profit hospitals, and Lillee Gelinas, vice president and CNO, says the organization knows that increasing the amount of time nurses spend at the bedside is key to optimal quality, safety, and patient experience outcomes. As a result, VHA embarked on a strategy in 2008 to address this issue, which it named retuRN to care.

VHA analyzed data from two organizations that had impressive nursing-at-the-bedside data: Cedars-Sinai Medical Center in LA and Barnes-Jewish St. Peters in Missouri.

"Through our qualitative research method, we created blueprints of their leading practices," says Gelinas. "They had eliminated hunting and gathering and waiting for information. Nurses spending a lot of time looking for equipment, going to the pharmacy to get drugs, looking for a wheelchair, waiting for doctors to call back, waiting for another department to call back with lab report or X-ray results."

VHA also had nurses track what they were doing during shifts and used PDAs to measure their time. After the study, they analyzed what nurses were doing that could be considered non-value added and developed ways to reduce those distractions.

Gelinas says some of the strategies that had most success involved technology, such as giving nurses cell phones so they didn't have to wait at nurses stations. Other benefits came from educating other departments and bringing them onboard. For example, nurses frequently had to go to the pharmacy for medications because pharmacy staff were too busy to deliver them. The retuRN to care initiative illuminated the issue for pharmacy staff, who could see the effect on patient care of nurses leaving the unit.

Other practices that worked include:

• Rounding hourly
• Conducting bedside shift reports (RN handoff at the bedside)
• Addressing medication administration inefficiencies
• Streamlining documentation
• Minimizing hunting and gathering activities related to equipment, supplies, and medications
• Enhancing care coordination communications:
  • Wireless phone technology
  • Whiteboard communications
  • Multidisciplinary rounds

The retuRN to care program has been a success. Gelinas says that 11 hospitals in the VHA Georgia rapid adoption network reported an initial nursing-at-the-bedside rate of only 30%. Since adopting retuRN to care, their rates now stand at more than 60%.

As regulatory monitoring of nursing-sensitive performance measures intensifies, increasing nurse's time at the bedside will be vital for ensuring safe, quality care. The failure to rescue data could be the first of many such measures that quantify the important work of nurses.

"The public reporting of data around what nurses do is catching some hospitals off guard," says Gelinas. "Why are so many not aware that CMS will begin tracking failure to rescue from claims data?"

If you're not being effective and efficient about getting nurses back to the bedside, it's going to show in failure to rescue data. Are you ready for June 1?