Editorial: failure to rescue: improving nursing care for older people

Failure to rescue is an area of research and service improvement that reflects the need for a broader focus on the quality of care for older patients. Using this as a quality indicator focuses attention on clinical work that must be done to rescue these patients. Dignity, compassion and the relational and emotional aspects of care are vitally important, but these are not the reasons people attend hospitals. Just as patients in the review of Bridges et al. (2010) may have taken the quality of clinical care for granted perhaps we too run the danger of doing so when we focus on how to measure dignity, but not on the quality and outcome of clinical care. We have looked for compassion but missed nursing interventions that might save lives.Many older people may be reaching a stage where palliation is a goal and death is anticipated. However, this is not the case for all, and it certainly does not offer an excuse for a failure to identify and decide on the appropriate intervention when complications occur. In a seamless approach, each aspect of care supports and enhances the other, such that successful relational practice helps nurses assess risk, to deal with the impact of illness for individuals and to recognise and respond to treatment needs while supporting patients and families to make decisions that reflect their wishes and best interests. If nursing teams are not adequately resourced and nurses not properly focussed on physical and emotional care, older patients’ clinical outcomes will continue to be suboptimal. Dignity and compassion are vital, and nursing care without them is shocking, but a failure to rescue the older people in our care may be an even bigger scandal.