Complications recognized too late

One term is failure to rescue. As a quality measure, the Patient Safety Network primer says, it has been defined as the inability to prevent death after development of a complication (opens in a new tab).

The primer describes three stages at which rescue fails: failure to recognize a complication, failure to relay information about it, and failure to react in a timely and appropriate manner (opens in a new tab).

The other is delay in treatment, a category of the serious events, in all kinds of care, that accredited organizations report to the Joint Commission voluntarily (opens in a new tab). Its review of 2024 data says the category includes delays in care or response, such as failure to recognize or respond to changes in a patient’s condition (opens in a new tab).

Both are terms of hospital quality review. Neither is a legal claim or a finding of fault.

Illinois hospital rules require that patients having major surgery be observed before and after the operation by a competent registered nurse specifically assigned to the patient (opens in a new tab), without defining major surgery or saying how often.

Federal rules for hospitals that take Medicare require adequate provisions for immediate post-operative care (opens in a new tab), and federal guidance to inspectors expects hospitals to set policies on the minimum scope and frequency of patient monitoring (opens in a new tab) after the recovery unit.

Illinois law requires each hospital to adopt, implement and periodically update evidence-based protocols for the early recognition and treatment of sepsis (opens in a new tab). The statute names no treatment times of its own. It does require each hospital’s protocol to include timeframe goals (opens in a new tab) for supporting the patient’s circulation, and the early delivery of antibiotics. Sepsis is what the Centers for Disease Control and Prevention (CDC) calls the body’s extreme response to an infection (opens in a new tab).

The Joint Commission’s goals for accredited hospitals, in force since January 2026, require written criteria describing early warning signs of a change or deterioration in a patient’s condition and the appropriate action to take (opens in a new tab). The American College of Surgeons’ principles say responsibility for postoperative care rests primarily with the operating surgeon (opens in a new tab).

These are the regulators’ and the profession’s own documents. What careful practice required for a particular patient after surgery is for a qualified surgeon to explain.

In a review covering 474,063 gynecologic laparoscopies (keyhole operations), most bowel injuries were recognized during the operation, but diagnosis was delayed by more than a day in 154 of 375 cases (41%) (opens in a new tab). All five deaths followed delayed recognition (opens in a new tab). Five is a small number. The studies date from 1972 to 2014, and the review did not ask whether any delay was negligent.

In a study of 84,730 patients having inpatient general or vascular surgery from 2005 to 2007, hospitals with very high and very low death rates had similar rates of major complications (opens in a new tab). Among patients who had one, mortality was almost twice as high in the hospitals with very high death rates (21.4% against 12.5%) (opens in a new tab). That compares hospitals and does not show that any one death was avoidable.

Studies of malpractice claims count claims. In the American College of Surgeons’ review of 460 claims against general surgeons, reviewers found care below accepted standards more often before and after operations than during them (opens in a new tab), often from a failure to recognize surgical injuries. The claims closed in 2003 or 2004, and reviewers found the care satisfactory in 36% of them (opens in a new tab). Those are shares of claims, never of patients, and say nothing about how often a complication is missed.

With the timeline. Such a claim is about recognition and response: whether the signs were there, who saw them, who was told and how quickly anyone acted.

In a 1965 case the Illinois Supreme Court said that once the danger signs appeared, it became the nurses’ duty to inform the attending physician, and if he failed to act, to advise the hospital authorities (opens in a new tab). The patient in that case had a broken leg in a cast. The nurses’ duty arose from watching that leg, before the operations that later tried to save it.

The committee that drafts Illinois’s pattern jury instructions says the standard of care may also be proven by hospital licensing regulations or accreditation standards (opens in a new tab). Those are the committee’s words, and it cites an Appellate Court decision for them. In the 1965 case above, the Illinois Supreme Court said such rules aided the jury and did not conclusively determine the standard of care (opens in a new tab). For a claim against a doctor or nurse, the committee adds that such evidence is not to be viewed as an alternative to expert testimony (opens in a new tab). Whether a departure from such a rule was negligent is decided on the evidence in each case.

The same instructions include one on a hospital’s own negligence (opens in a new tab). Our page on Illinois malpractice law covers the deadlines, the reviewing health professional’s report and who can be held responsible.

Illinois hospital rules list observation notes and vital sign charting made by nursing personnel (opens in a new tab) among the minimum contents of every hospital record, and require the assigned nurse’s observations of a major-surgery patient to be documented in the patient’s record (opens in a new tab).

Read as a timeline, the vital signs, the nursing notes and any record of calls to a physician are where the timing shows.

You can ask the hospital for these records, and our Illinois law page explains how to request them. It helps to write down when the symptoms began, whom you or your family told and when, and what you were told in return.