Safety Net Hospitals: Death Rates After Major Complications

Elliot Wakeam MD Center for Surgery and Public Health Brigham and Women's Hospital Boston MA Interview with
Elliot Wakeam MD
Center for Surgery and Public Health
Brigham and Women’s Hospital
Boston MA 02115 What are the main findings of the study?

Dr. Wakeam: Our study examined failure to rescue (FTR), or death after postoperative complications, in safety net hospitals. Prior work has shown that hospital clinical resources can improve rescue rates, however, despite having higher levels of technology and other clinical resources that should lead to better rates of patient rescue, safety net hospitals still had greater rates of death after major complications. Were any of the findings unexpected?

Dr. Wakeam: The conventional wisdom regarding safety net hospitals would suggest that difficult financial circumstances lead to poor access to high technology and clinical resources. This concept has been used to partially explain poor outcomes in these facilities that have been shown in prior research. However, we in fact found that safety net hospitals had the same or greater access to many resources. Despite greater access to advanced resources and technology, their mortality and FTR rates were still greater. What should clinicians and patients take away from your report?

Dr. Wakeam: Our report suggests that safety net hospitals need to focus on organizational factors, as well as ways to better utilize the resources which they do possess, to improve patient rescue. There is no doubt that safety net hospitals serve a vital role in our society, and serve a challenging patient population, but new strategies are needed to address emerging disparities in care. Furthermore, any existing financial and clinical disparities in safety net hospitals will be exacerbated in states that do not expand Medicaid, because uncompensated care payments to these hospitals are set to be eliminated under the Affordable Care Act. What recommendations do you have for future research as a result of this study?

Dr. Wakeam: Future research on FTR needs to ‘drill down’ on the organizational and hospital cultural factors that may impact FTR. Safety net hospitals need to focus on these elements as they attempt to improve FTR. Policy makers will need to grapple with the impact of decreasing funds for uncompensated care, and the adverse impact that this will have on struggling safety net hospitals.

Failure to Rescue in Safety-Net Hospitals
Availability of Hospital Resources and Differences in Performance

Wakeam E, Hevelone ND, Maine R, et al. Failure to Rescue in Safety-Net Hospitals: Availability of Hospital Resources and Differences in Performance. JAMA Surg. 2014;():. doi:10.1001/jamasurg.2013.3566

Last Updated on March 19, 2014 by Marie Benz MD FAAD