Audrey Provenzano1, Shannon Rohan2, Elmy Trevejo2, Elisabeth Burdick3, Stuart Lipsitz3, Allen Kachalia3. 1. Department of Medicine Residency Program, Brigham and Women's Hospital, Boston, Massachusetts, USA. 2. Brigham & Women's Hospital, Boston, Massachusetts, USA. 3. Division of General Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Abstract
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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Authors: Jacqueline A Griffin; Kevin Carr; Kerrin Bersani; Nicholas Piniella; Daniel Motta-Calderon; Maria Malik; Alison Garber; Kumiko Schnock; Ronen Rozenblum; David W Bates; Jeffrey L Schnipper; Anuj K Dalal Journal: Diagnosis (Berl) Date: 2021-08-23
Authors: Daniel M Kobewka; Carl van Walraven; Jeffrey Turnbull; James Worthington; Lisa Calder; Alan Forster Journal: BMJ Qual Saf Date: 2016-02-08 Impact factor: 7.035
Authors: Carrie A Herzke; Christine G Holzmueller; Michael Dutton; Allen Kachalia; Peter M Hill; Elliott R Haut Journal: Am J Med Qual Date: 2022-05-13 Impact factor: 1.200