A Concept Analysis on Failure to Rescue in Maternal Health: Implications for Practice and Policy

Although "Failure to Rescue" (FTR) has been widely studied in general healthcare contexts, and a few clinical specialties, its definition and implications remain underexplored within maternal health, particularly given the heightened risks for marginalized women. The quality measure was retired as a national quality metric before formal adoption into obstetric care, leaving significant gaps in maternal patient safety. High rates of preventable maternal morbidity and mortality, highlight the urgent need to explore and define this concept specifically within maternal health.

To conduct a concept analysis of FTR in obstetrics, examining systemic patient safety failures using both Charles Vincent's patient safety framework and Reason's Swiss Cheese Model of human error, and propose strategic improvements for maternal care delivery.

A comprehensive literature search guided by Walker and Avant's concept analysis method was performed, synthesizing evidence from multidisciplinary sources on failure to rescue, and maternal morbidity, and mortality on national patient safety. A systematic review of obstetric and patient safety literature was conducted using PubMed, CINAHL, MEDLINE, Google Scholar, and The Cochrane Library. In total, 30 articles met the inclusion criteria, including those outside of U.S. health systems. Key themes relating to system failures, nurse staffing, and obstetric complications were extracted to refine FTR's defining attributes, antecedents, and outcomes for maternal care.

Analysis revealed FTR in obstetrics involves multiple, intersecting system-level breakdowns rather than isolated provider errors. The failure to rescue factors identified include inadequate recognition of clinical deterioration, delayed escalation of care, fragmented interdisciplinary communication, and biases exacerbating health disparities. Amber Rose Isaac's model case exemplified intersection of the following factors: critical lab results were missed, warnings of severe complications were ignored, and pandemic-induced care constraints further compromised and compounded timely intervention.

Although the formal FTR measure was retired prior to adoption in obstetrics, addressing many of the underlying systemic failures described in this analysis is essential. Integrating proactive, standardized maternal early-warning systems, surveillance monitoring systems, and robust policies to ensure equitable care is crucial. Re-envisioning maternal safety through the lens of FTR not only addresses immediate clinical gaps, but also aligns healthcare practice with its fundamental ethical duty to protect every woman, family, and community from preventable harm.