In 2022, roughly 1 in 8 patients who developed a post-surgical complication at a low-performing U.S. hospital died from it. At a high-performing hospital, that ratio was closer to 1 in 20. Nobody told them to check before they signed the consent form.
Do you know your hospital’s failure-to-rescue rate?
If that term is unfamiliar, you are not alone in this. Most patients have never heard it. Most primary care physicians do not bring it up. And yet, according to a landmark study published in the New England Journal of Medicine by researchers at Brigham and Women’s Hospital, failure-to-rescue, which is the rate at which hospital staff fail to prevent a patient’s death after a serious complication develops, is one of the strongest predictors of surgical mortality in the United States. More predictive, in many cases, than a hospital’s star rating, its U.S. News ranking, or how new its lobby looks.
What “Failure-to-Rescue” Actually Means
The clinical term sounds cold, but the reality behind it is deeply human.
Failure-to-rescue (FTR) measures what happens after something goes wrong during or after surgery. Complications happen at every hospital. Infections develop. Blood clots form. Patients develop sepsis, a dangerous bloodstream infection where bacteria enter the bloodstream and begin attacking organs. The question is not whether complications occur. The question is: what happens at this specific hospital when they do?
A high-performing hospital catches the early warning signs fast. Nurses are trained to escalate. Rapid response teams are staffed around the clock. Protocols exist for 3 a.m. as much as for 3 p.m.
A low-performing hospital may not have those systems in place. And that gap is where patients die from complications that were, in principle, survivable.
The Patient Nobody Told
Consider what happened to a 67-year-old retired teacher in Ohio. Call her Margaret. She chose her hospital for a hip replacement based on its strong U.S. News regional ranking and the fact that her surgeon had trained at a prestigious institution. Her surgery went smoothly. Her post-op infection did not. Margaret’s fever climbed through hour 19 before a floor nurse flagged it and called for escalation. At a hospital with high-functioning rapid response protocols, that same fever would have triggered an alert at hour 4. Same complication. Fifteen fewer hours of unchecked infection. Very different outcome. The only variable was which hospital her surgeon had admitting privileges at.
Have you ever asked your hospital what its failure-to-rescue rate is, or whether it even tracks that data publicly?
Margaret had no idea she could ask.
Why Nobody Checks This (and Why That Makes Sense)
This is not a story about patient ignorance. There is a real structural reason this metric stays invisible.
When most people research a hospital, they use tools built for visibility, not accuracy. They check Yelp reviews. Quality reporting, where it exists, tends to be buried inside government databases with interfaces that were not designed for ordinary people to navigate on a Tuesday night before a pre-op appointment. The Centers for Medicare and Medicaid Services (CMS) publishes failure-to-rescue data through its Care Compare tool, but the pathway to find it is not obvious, and nothing in the pre-surgical process prompts patients to look.
Add to that the fact that most surgeons, who are often excellent at their specific procedure, work across multiple hospitals and may not know their own hospital’s comparative FTR data. A 2023 report from the Agency for Healthcare Research and Quality (AHRQ) found that fewer than 40% of surgeons surveyed could accurately describe their primary hospital’s performance on Patient Safety Indicators, the federal benchmarks that include failure-to-rescue.
This matters even more if you or a family member is managing a chronic condition that raises surgical risk. Diabetes, heart disease, and obesity all increase the likelihood of post-surgical complications, which means the hospital’s ability to respond to those complications becomes even more critical than the surgery itself.
Did You Know: The AHRQ Patient Safety Indicator 02 (PSI-02) specifically tracks failure-to-rescue rates across U.S. hospitals. CMS publishes this data publicly through its Care Compare platform at medicare.gov/care-compare. Most patients never access it.
What Most Doctors Do Not Tell You
In my years of research, the pattern I kept seeing was this: patients optimized for the surgeon and ignored the institution. That instinct is understandable. The surgeon is who you meet. The surgeon is who explains the plan. But the surgeon goes home. The institution stays.
Research shows that institutional factors, including nursing ratios, rapid response team staffing, and post-surgical monitoring protocols, account for a significant share of the variation in failure-to-rescue rates across U.S. hospitals. A 2019 analysis published in JAMA Surgery found that hospitals with higher registered nurse staffing levels had failure-to-rescue rates up to 16% lower than comparable institutions with leaner staffing. The surgeon’s skill matters enormously. So does whether the night-shift nurse has the authority and support system to escalate a fever at 3 a.m.
When did you last check whether your hospital publicly reports its complication response data?
Warning: A hospital’s overall star rating does not reflect its failure-to-rescue performance. A hospital can score 4 stars on CMS overall quality measures while performing in the bottom quartile on failure-to-rescue. These are different measurements. Checking only the star rating gives you an incomplete picture of surgical safety.
Pro Tip: Before any elective procedure, call the hospital’s quality department directly, not patient services, and ask for their Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator scores. Most will provide them. The ones that hesitate are telling you something.
The Science Is Actually Fascinating Here
What makes high-performing hospitals different is not usually a single technology or one brilliant administrator. Research shows it is almost always a system of responses working together: standardized early warning score protocols, nursing empowerment to call rapid response without physician approval, simulation-based training for post-surgical deterioration, and leadership cultures that do not punish escalation.
These are things you cannot see on a hospital tour. But you can see them in the data.
The Leapfrog Group, a nonprofit patient safety organization, publishes an annual Hospital Safety Grade that incorporates failure-to-rescue performance alongside other Patient Safety Indicators. Their 2023 report found that patients at “A”-rated hospitals were significantly less likely to die from a preventable complication than those at “C”-rated hospitals, even when the procedures performed were identical.
This is also worth keeping in mind if you are planning any kind of procedure while traveling or far from home. Just as understanding the timing rules of travel insurance can protect your finances, understanding hospital quality data protects something far less replaceable. And for older adults, the stakes are even sharper. The access and timing issues explored in the 6-week waitlist blocking seniors from flu protection reflect a broader pattern: the healthcare system does not always surface critical information at the moment patients most need it.
Your Next 3 Steps
You do not need a healthcare background to do this. Each of these takes under 10 minutes.
Step 1: Go to medicare.gov/care-compare tonight and search your hospital by name or ZIP code. Look for the section labeled “Serious complications after surgery” and screenshot the results. That screenshot goes to your pre-op appointment.
Step 2: Visit hospitalsafetygrade.org, enter your hospital’s name, and write down two numbers: its letter safety grade and its failure-to-rescue percentile ranking. If your hospital scores below the 50th percentile on failure-to-rescue, that is a specific, concrete question to bring to your surgeon.
Step 3: At your next pre-op appointment, ask your surgeon this exact question: “What is this hospital’s failure-to-rescue rate for my procedure, and how does it compare to the state average?” The discomfort of that conversation is worth every second of it. A surgeon who cannot answer it, or who dismisses the question, has told you something important.
You are not alone in this. Most patients have never been handed this information, because nobody built a system that requires handing it over. But the data exists. The tools are free. And the question is simple enough to ask.
Margaret deserved to know before she checked in. So do you.
