The Failure to Rescue Process and Nonreassuring Fetal Heart Rate Patterns

Abstract
Failure to rescue, or the failure to diagnose and treat in time, has been expanded beyond an outcomes measurement of hospital performance and medical care to a process measurement. The four essential components of the rescue process include: (a) careful surveillance, (b) timely identification, (c) appropriate intervention, and (d) activation of team response. Failure to rescue has only recently been applied to nursing and has never been studied in the obstetrical setting. 
This study evaluated clinical responses to the key components of the failure to rescue process in women
(N = 53) who had a cesarean birth at term gestation for a nonreassuring fetal heart rate pattern using AHRQ’s Failure to Rescue Patient Safety Indicator Adapted for Perinatal Care Processses.
Research Questions:
1. What is the perinatal team’s total score as measured by the failure to rescue process tool for clinical
responses to nonreassuring fetal heart rate patterns in
pregnant laboring women?
2. What are the subscale scores for each of the four components of the rescue process tool (careful monitoring, timely identification, appropriate intervention, and activation of team response)?
Research Design
This was a retrospective descriptive study of review of medical records.  
Results
Mean maternal age was 25.7 years. Fifty seven percent of women had Medicaid insurance. Resident physicians managed 53% of the cases. The perinatal team’s mean total score was 6.6 (SD = 1.0) out of a possible score of 8. Mean subscale scores for each of the rescue components ranged from (1.2 - 2.0) out of a possible 2 for each category. The lowest subscale score occurred in appropriate interventions, illustrating the need for education to ensure 100% compliance with protocols. This study provides information that will be useful in evaluating the processes of care to ensure quality of care for mothers and babies.