TY - JOUR
T1 - Evaluating inpatient mortality
T2 - A new electronic review process that gathers information from front-line providers
AU - Provenzano, Audrey
AU - Rohan, Shannon
AU - Trevejo, Elmy
AU - Burdick, Elisabeth
AU - Lipsitz, Stuart
AU - Kachalia, Allen
N1 - Publisher Copyright:
© 2015, BMJ Publishing Group. All rights reserved.
PY - 2015/1/1
Y1 - 2015/1/1
N2 - Importance: Accurately and routinely identifying factors contributing to inpatient mortality remains challenging. Objective: To describe the development, implementation and performance of a new electronic mortality review method 1 year after implementation. Methods: An analysis of data gathered from an electronic instrument that queries front-line providers on their opinions on quality and safety related issues, including potential preventability, immediately after a patient's death. Comparison was also made with chart reviews and administrative data. Results: In the first 12 months, reviewers responded to 89% of reviews sent (2547 responses from 2869 requests), resulting in at least one review in 99% (1058/1068) of inpatient deaths. Clinicians provided suggestions for improvement in 7.7% (191/2491) of completed reviews, and reported that 4.8% (50/1052) of deaths may have been preventable. Quality and safety issues contributing to potentially preventable inpatient mortality included delays in obtaining or responding to tests (15/50, 30%), communication barriers (10/50, 20%) and healthcare associated infections (9/50, 18%). Independent, blinded chart review of a sample of clinician reviews detected potential preventability in 10%(2/20) of clinician reported cases as potentially preventable. Comparison with administrative data showed poor agreement on the identification of complications with neither source consistently identifying more complications. Conclusions: Our early experience supports the feasibility and utility of an electronic tool to collect real-time clinical information related to inpatient deaths directly from front-line providers. Caregivers reported information that was complementary to data available from chart review and administrative sources in identifying potentially preventable deaths and informing quality improvement efforts.
AB - Importance: Accurately and routinely identifying factors contributing to inpatient mortality remains challenging. Objective: To describe the development, implementation and performance of a new electronic mortality review method 1 year after implementation. Methods: An analysis of data gathered from an electronic instrument that queries front-line providers on their opinions on quality and safety related issues, including potential preventability, immediately after a patient's death. Comparison was also made with chart reviews and administrative data. Results: In the first 12 months, reviewers responded to 89% of reviews sent (2547 responses from 2869 requests), resulting in at least one review in 99% (1058/1068) of inpatient deaths. Clinicians provided suggestions for improvement in 7.7% (191/2491) of completed reviews, and reported that 4.8% (50/1052) of deaths may have been preventable. Quality and safety issues contributing to potentially preventable inpatient mortality included delays in obtaining or responding to tests (15/50, 30%), communication barriers (10/50, 20%) and healthcare associated infections (9/50, 18%). Independent, blinded chart review of a sample of clinician reviews detected potential preventability in 10%(2/20) of clinician reported cases as potentially preventable. Comparison with administrative data showed poor agreement on the identification of complications with neither source consistently identifying more complications. Conclusions: Our early experience supports the feasibility and utility of an electronic tool to collect real-time clinical information related to inpatient deaths directly from front-line providers. Caregivers reported information that was complementary to data available from chart review and administrative sources in identifying potentially preventable deaths and informing quality improvement efforts.
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U2 - 10.1136/bmjqs-2014-003120
DO - 10.1136/bmjqs-2014-003120
M3 - Article
C2 - 25332203
AN - SCOPUS:84921637736
SN - 2044-5415
VL - 24
SP - 31
EP - 37
JO - BMJ Quality and Safety
JF - BMJ Quality and Safety
IS - 1
ER -