Preventable Mortality Summary:
Preventable mortality refers to avoidable inpatient hospital deaths, those that are not an expected or probable outcome of a patient's hospital stay. There is a growing recognition that organizational interventions to improve patient care planning, enhance communication among caregivers, better asses patient risk of death, better respond to signals of deteriorating patient health, and adoption of evidence-based care practices and protocols can reduce preventable deaths.
What are the Causes and Risk Factors?
Sepsis is the leading cause of death in non-coronary care intensive care units in the United Sates, with a mortality rate between 30% and 50% (Surviving Sepsis Campaign, 2008). Sepsis occurs when the immune system's reaction to an infection may injure body tissues far from the original infection. As sepsis progresses, it begins to affect organ function and eventually can lead to septic shock - a sometimes fatal drop in blood pressure. The leading principal diagnosis for inpatient deaths in U.S. hospitals in 2007 was septicemia, the principal diagnosis in 15 percent of deaths (AHRQ Statistical Brief #81 rev. April 2010) In Massachusetts, deaths (1,954) of patients who developed sepsis after admission to the hospital accounted for 12.1 percent of all in-hospital deaths in FY 2009, resulting in 20.8-day hospital average length of stay and $82,553 average cost per case (MA DHCFP acute care hospital discharge database for FY 2009, analysis from the MA Health Data Consortium).
Other leading diagnoses associated with high rates of inpatient deaths nationwide are respiratory failure (17 percent death rate, 9 percent of deaths), aspiration pneumonitis (13 percent death rate, 3 percent of deaths), cancer of the bronchus (11 percent death rate, 2 percent of deaths) and acute cerebrovascular disease (9 percent death rate, 6 percent of deaths). Seventy-two percent of patients that died were emergency admissions and 73 percent had one or more procedures during the hospital stay (AHRQ Statistical Brief #81 rev. April 2010).
What Can Hospitals Do to Reduce Preventable Mortality?
MHA offers programs to assist hospitals in building an effective hospital mortality review program and implementing evidence-based strategies to reduce mortality for those patients and conditions at greatest risk. This initiative is called Mortality: Learning-in-Network (M-LiNk).
M-LiNk includes:
Learning series with local/national expertise on interventions associated with best practice for reducing hospital mortality rates;
Website resources via PatientCareLink with tools & resources in key content areas;
Virtual networking to foster inquiries, share resources, and promote learning across hospitals;
Individualized technical assistance to support implementation of selected interventions; and
Communications via MHA's website and Issues Briefs to present case studies and highlight lessons learned.
See the sidebar link to information on M-LiNk and AIMS: The Assessment of Improvement Methodology of Sepsis.
WORKING TO REDUCE PREVENTABLE MORTALITY: A Resource You Can Use
As part of its Hospitals in Pursuit of Excellence initiative, the American Hospital Association recently released Hospital Strategies for Reducing Mortality, providing a broad overview of key steps that hospital and health system leaders may take in developing a strategy for reducing preventable in-patient deaths. The publication also includes a list of resources available to help healthcare providers and health systems reduce mortality.