“We decided that we should get organized in a very deliberate way and study every death,” said UPHS Chief Medical Officer Dr. Patrick Brennan. He assembled a team of physicians, nurses and administrators to analyze outcomes and develop strategies to improve performance.
The committee's review of the system's electronic health records pointed to two glaring problems: excess mortality among patients with sepsis or delirium, the severe confusion that often accompanies hospitalization. Delirium was triggering numerous falls and breathing problems that led to unnecessary deaths.
UPHS is one of many hospitals and systems under increased pressure to decrease death rates since the CMS began requiring hospitals to publicly post outcomes data. Providers—even elite institutions such as UPHS—could lose patients when they start comparing mortality rates.
Many factors can drive up that rate, not only sepsis or delirium, and all can be prevented, said Dr. Don Goldmann, chief medical and scientific officer at the Institute for Healthcare Improvement. Hospitals must first identify the specific problems driving their own excessive mortality rate.
“Hot spots account for a very large population of the deaths and are areas for improvement in most hospitals,” Goldmann said. “Identifying these opportunities for quality improvement is vital.”
UPHS began its process by using data from the University HealthSystem Consortium to set benchmarks. UPHS then upgraded its data collection process by tapping a registered nurse to input deceased patient information into its EHR, which was reviewed by a physician.
A new mortality review committee recognized from the outset that physicians needed to shape the strategy for the quality-improvement initiatives if it was to be accepted by clinicians. Peer development—not something forced on them by the UPHS administration—was key.
Physicians began filling out forms that included their opinion on the cause of patient death and whether it was preventable. It was physicians who identified the major problems that led to poor outcomes.