The University of Pennsylvania Health System Reduces its Mortality Index
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(Oak Brook Ill.) Today, Joint Commission Resources announced the release of the September 2013 issue of the “The Joint Commission Journal on Quality and Patient Safety,” featuring an article on how the University of Pennsylvania Health System decreased its mortality index by more than half. In “The Mortality Review Committee: A Novel and Scalable Approach to Reducing Inpatient Mortality,” John S. Barbieri, B.A., and his co-authors describe the University of Pennsylvania Health System’s mortality review committee, which was created in 2006 to reduce inpatient mortality, as measured by the University HealthSystem Consortium (UHC) mortality index – observed/expected mortality. By 2012, the mortality index decreased from 1.08 to 0.53, with observed mortality decreasing from 2.45 percent to 1.62 percent.
The University’s Mortality Review Committee implemented a three-pronged approach, which entailed analysis of administrative claims records, a 360-degree online survey to elicit providers’ opinions of the preventability of each inpatient death, and an enhanced chart review process. In doing so, the committee identified multiple opportunities to improve the quality of inpatient care, including sepsis survival and delirium recognition.
The organization established mortality reduction as a priority, and executive leadership and all departmental chairs were challenged to achieve reductions in mortality. The authors conclude that alignment of organizational priorities, incentives, and leadership paved the way for the success of the Mortality Review Committee.
“The Joint Commission Journal on Quality and Patient Safety,” published monthly by Joint Commission Resources, is a peer-reviewed journal, available by subscription, which serves as a forum for practical approaches to improving quality and safety in health care.
Methods, Tools, and Strategies
The Mortality Review Committee: A Novel and Scalable Approach to Reducing Inpatient Mortality
John S. Barbieri, B.A.; Barry D. Fuchs, M.D., M.S., FACP; Neil Fishman, M.D.; Carolyn Crane Cutilli, R.N., Ph.D-c., M.S.N, ONC, CRRN; Craig A. Umscheid, M.D., M.S.C.E.; Craig Kean, M.S.; Sherine Koshy, M.H.A., RHIA, CCS; Patricia Garcia Sullivan, Ph.D.; PJ Brennan, M.D.; Rachel R. Kelz, M.D., M.S.C.E.
During the first six years of the University of Pennsylvania Health System’s Mortality Review Committee, the mortality index (observed/expected mortality) decreased from 1.08 to 0.53. Sepsis management improvements were associated with increases in severe sepsis survival (40 percent to 56 percent) and septic shock survival (42 percent to 54 percent), as well as a decrease in the mortality index (2.45 to 0.88). Delirium management improvements were associated with an increase in the proportion of patients receiving a “timely” intervention (18 percent to 57 percent) and a twofold increase in the percentage of patients discharged to home.
Using Four-Phased Unit-Based Patient Safety Walkrounds to Uncover Correctable System Flaws
April M. Taylor, M.S., M.H.A., CPHQ; John Chuo, M.D., M.S.; Ana Figueroa-Altmann, M.S.N, R.N., DM(c); Susan DiTaranto, M.H.A., R.N.; Kathy N. Shaw, M.D., M.S.C.E.
A unit-based Patient Safety Leadership WalkroundsTM (PSWR) model, adapted to include four phases, was deployed in six medical/surgical units at The Children’s Hospital of Philadelphia. Leaders in all units indicated that PSWR helped them to uncover previously unidentified safety concerns. Top-impact areas included nurse-medical team relationship, work-flow flaws, equipment defects, staff education, and medication safety.
Pressure Ulcers and Prevention Among Acute Care Hospitals in the United States
Sandra Bergquist-Beringer, Ph.D., R.N., CWCN; Lei Dong, M.S.; Jianghua He, Ph.D.; Nancy Dunton, Ph.D., FAAN
Many studies describe implementation of pressure ulcer prevention programs but few report the effect on outcomes across acute care facilities. For a sample of 1,419 hospitals and 710,626 patients in adult critical care, step-down, medical, surgical, and medical/surgical units, data from the National Database of Nursing Quality Indicators® 2010 Pressure Ulcer Surveys (first- through fourth-quarter data) showed a rate of hospital-acquired pressure ulcers of 3.6 percent across all surveyed patients. The results provide empirical support for pressure ulcer prevention guideline recommendations, but the 7.9 percent rate of hospital-acquired pressure ulcers among patients at risk suggests room for improvement in pressure ulcer prevention.
Health Information Technology and Hospital Patient Safety: A Conceptual Model to Guide Research
Kathryn Paez, R.N., Ph.D.; Rebecca A. Roper, M.S., MPH; Roxanne M. Andrews, Ph.D.
The literature indicates that health information technology (IT) use may lead to some gains in the quality and safety of care in some situations but provides little insight into this variability in the results. A conceptual model was developed that describes the impact of specific health IT functions on different types of inpatient safety errors. The model also addresses contextual factors that influence successful health IT implementation. The model may inform the development of new tools measuring IT use, the design of studies of the impact of health IT on patient safety, and factors to consider when deploying health IT systems.
Health Professions Education
“Excuse Me:” Teaching Interns to Speak Up
Paul O’Connor, Ph.D., M.Sc., CPsychol; Dara Byrne, M.B., B.Ch., B.A.O., FRCSI; Angela O’Dea, Ph.D., M.Sc.; Terri P. McVeigh, M.B., B.Ch., B.A.O., FRCSI; Michael J. Kerin, M.Ch., FRCSI
Training designed to encourage interns to “speak up” at University Hospital Galway (Ireland) entailed the exposure of 110 interns to filmed stories of attending physicians describing situations in which, as interns, their own communication and assertiveness skills were challenged. The evaluation showed a significant increase in knowledge but no effect on behavior. A sustained change in attitudes and behavior to speaking up will require a reinforcement of learning with deliberate practice to develop the skills introduced through the training program.