'Failure to rescue' as a measure of quality of hospital care: the limitations of secondary diagnosis coding in English hospital data

Although it is widely recognized that quality of care varies between hospitals, a robust and valid measure of outcome that can be used in comparisons has proven elusive. One measure that has recently been proposed by US researchers is the 'failure to rescue' (FTR) rate. This is based on the assumption that, whereas complications may reflect both patient severity and health care factors, the ability to save patients once complications arise is much more closely related to the quality of health care. We describe an evaluation of FTR in a national sample of English hospitals using hospital episode data. We found that the rate of secondary diagnosis recording in England is about one-tenth that in the United States. The FTR rate would be highly sensitive to variations in the completeness of coding of secondary diagnoses. Unless coding is of uniformly high quality, any attempt to compare severity adjusted outcomes will be potentially unreliable.