The Mortality Review Committee: A Novel and Scalable Approach to Reducing Inpatient Mortality

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Article-at-a-Glance

Background

Despite the importance of reducing inpatient mortality, little has been reported about establishing a hospitalwide, systematic process to review and address inpatient deaths. In 2006 the University of Pennsylvania Health System’s Mortality Review Committee was established and charged with reducing inpatient mortality as measured by the mortality index—observed/expected mortality.

Methods

Between 2006 and 2012, through interdisciplinary meetings and analysis of administrative data and chart reviews, the Mortality Review Committee identified a number of opportunities for improvement in the quality of patient care. Several programmatic interventions, such as those aimed at improving sepsis and delirium recognition and management, were initiated through the committee.

Results

During the committee’s first six years of activity, the University HealthSystem Consortium (UHC) mortality index decreased from 1.08 to 0.53, with observed mortality decreasing from 2.45% to 1.62%. Interventions aimed at improving sepsis management implemented between 2007 and 2008 were associated with increases in severe sepsis survival from 40% to 56% and septic shock survival from 42% to 54%. The mortality index for sepsis decreased from 2.45 to 0.88. Efforts aimed at improving delirium management implemented between 2008 and 2009 were associated with an increase in the proportion of patients receiving a “timely” intervention from 18% to 57% and with a twofold increase in the percentage of patients discharged to home.

Discussion

The establishment of a mortality review committee was associated with a significant reduction in the mortality index. Keys to success include interdisciplinary membership, partnerships with local providers, and a multipronged approach to identifying important clinical opportunities and to implementing effective intervention

Section snippets

Setting

The University of Pennsylvania Health System (Philadelphia) is a large (772-bed) urban teaching hospital staffed by more than 1,950 registered nurses and 1,600 physicians and house staff. There are approximately 37,000 admissions annually. Most clinical services sponsor graduate medical education programs. The chief medical officer [P.J.B.], an active infectious disease specialist, reports directly to the chief executive officer and thus has access to hospital resources to support his efforts.

Targeting Reduction in the Mortality Index

Mortality Index and Observed Mortality Rate

In 2009 the Center for Evidence-based Practice at Penn Medicine was asked to examine the impact of the Mortality Review Committee on the mortality index. Given that the committee was established in 2006, the center examined the time period from 2006 to 2009. During this period, numerous quality interventions occurred simultaneously (Table 1; and Table 2, right). Thus, it was not possible to identify direct causal relationships between any one intervention and improvements in mortality; however,

Discussion

We have described the use of a multidisciplinary mortality review committee to address inpatient mortality at a large, urban academic hospital. The diversity of the committee membership encouraged a multipronged approach to QI initiatives. Highlighting two initiatives developed and implemented by the committee to address sepsis and delirium, we demonstrate the enormous success that can be achieved through a systematic approach to mortality reduction. With 37,000 admissions annually, the

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