635 © Springer International Publishing Switzerland 2017 J.A. Sanchez et al. (eds.), Surgical Patient Care, DOI 10.1007/978-3-319-44010-1_37 Failure to Rescue and Failure to Perceive Patients in Crisis Christian Peter Subbe and Paul Barach C.P. Subbe, DM, MRCP (*) Department of Internal Medicine, Ysbyty Gwynedd, Penrhosgarnedd, Bangor, Gwynedd LL57 2PW, UK School of Medical Sciences, Bangor University, Bangor LL57 2AS, UK e-mail: csubbe@hotmail.com P. Barach, BSc, MD, MPH Clinical Professor, Children’s Cardiomyopathy Foundation and Kyle John Rymiszewski Research Scholar, Children’s Hospital of Michigan, Wayne State University School of Medicine, 5057 Woodward Avenue, Suite 13001, Detroit, MI 48202, USA e-mail: pbarach@gmail.com 37 “Failure isn’t fatal, but failure to change might be.” —John Wooden Failure to Rescue and the Context of Surgical Patient Management Definition The hallmark of a safe and reliable hospital is the ability to identify, address, and prevent a compli- cation from leading to lasting patient harm and suffering with safety defined as “freedom from accidental injury” [1]. Failure to rescue surgical patients is defined as mortality after a complica- tion occurring in patients who are hospitalized after a surgical procedure or with surgical disease. Initially limited to surgical patients the term has subsequently been used more broadly in the con- text of patients who suffer avoidable complica- tions despite visible and early warning signs. The original work on failure to rescue focused on coded complications following surgical complica- tions and subsequent mortality and morbidity [2]. Failure to rescue is an important metric from the point of view of patients, health care professionals, and health care organizations. Efforts have been focused on reducing complications of surgical pro- cedures by improving the awareness and perfor- mance of the surgical microsystem while optimizing infection risk through better hygiene and preventa- tive measures and optimizing team related pro- cesses through usage of checklists [3] and changes in the team culture [4]. At the same time variability in patients, surgical performance, human errors, unpredictable and preventable technical faults, and simple bad luck may mean that a percentage of patients will suffer complications even in a vastly improved system [5]. In these circumstances patients need to be reassured that every effort is being made to detect the complication, treat it and restore them to their full health [6]. Health care pro- fessionals would like to be reassured that their errors do not result in fatal outcomes or impact on the chronic health of their patients, both for their own peace of mind and their standing amongst their peers [7]. Healthcare organizations need to reassure themselves that a single error or mishap does not lead to long-term cost implications and legal and professional consequences. The management of failure to rescue has been seen as the hallmark of the best performing health systems. A 2009 analysis of US Medicare data from the 20 % hospitals with the best adjusted mortality rates and the 20 % hospitals with the worst mortality