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Case Study

How Top Hospitals Drive Real-Time Progress on Mortality Reduction

15 Minute Read

Overview

The challenge

Medical errors and other preventable factors are some of the leading causes of in-hospital deaths. While 100% mortality reviews are foundational to inpatient mortality-reduction efforts, most review processes are not effective in identifying the root causes of errors, closing the feedback loop with clinicians, and surfacing opportunities for improvement. Health systems are looking for the next set of approaches to drive progress on mortality-reduction efforts.

The organizations

Brigham and Women’s Hospital is an academic medical center based in Boston, Massachusetts. It is part of Mass General Brigham, an integrated health care system that consists of 16 member institutions. Mayo Clinic is a nonprofit medical center focused on integrated health care, education, and research, and is headquartered in Rochester, Minnesota. St. Joseph Mercy is a five-hospital health system based in Ann Arbor, Michigan, and is part of Trinity Health.

The approaches

Brigham and Women’s, Mayo Clinic, and St. Joseph Mercy recognized 30-day mortality as one of the most significant areas of opportunity to drive practice improvement. Leaders at Brigham and Women’s and Mayo Clinic expanded mortality initiatives by focusing on capturing more real-time, multidisciplinary input from frontline staff and disseminating actionable feedback to providers. Leaders at St. Joseph Mercy focused on identifying patients at risk of 30-day mortality at the point of admission.

The result

After implementing these approaches, leaders identified several system- and facility-level opportunities for care practice improvement and consequently have seen quality gains and reductions in mortality. Additionally, these approaches have helped facilitate cross-disciplinary relationships among staff.

 

Approaches to reducing mortality

How Brigham and Women’s, Mayo Clinic, and St. Joseph Mercy expanded their mortality-reduction efforts

Brigham and Women’s, Mayo Clinic, and St. Joseph Mercy recognized that 100% mortality reviews are foundational to mortality-reduction efforts. However, to drive real-time improvement on mortality, these organizations took their initiatives a step further by automating processes surrounding mortality, standardizing data collection efforts, and collecting interdisciplinary input.

 

Three approaches to drive progress on reducing 30-day mortality

 

  • Approach

    Solicit comprehensive, real-time provider input

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  • Approach

    Establish cross-functional mortality review forums

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  • Approach

    Proactively screen patients at risk of 30-day mortality

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Results

How we know it’s working

By implementing one or more of these approaches at their organization, Brigham and Women’s, Mayo Clinic, and St. Joseph Mercy are already seeing signs of success.

  • Brigham and Women’s Hospital: Over more than seven years of implementing the mortality review tool, Brigham and Women’s Hospital leaders have identified and addressed several system-level opportunities for improving care delivery. Sample efforts focused on improving communication between primary and ancillary teams, standardizing end-of-life discussions, and adapting EHR alerts for high-risk situations to address medication errors.
  • Mayo Clinic: Although Mayo Clinic’s weekly mortality review huddles began only recently, they are already seeing benefits. The huddle has improved relationships between medicine, surgery, nursing, CDI, and pharmacy staff. Additionally, the huddles have facilitated cross-discipline learning among these groups.
  • St. Joseph Mercy: Since implementing the mortality risk score at their Ann Arbor location, St. Joseph Mercy has seen a 14% reduction in 30-day mortality, 21% reduction in unplanned transfers to the ICU within the first 24 hours of admission, 12% reduction in 30-day readmissions for patients discharged to skilled nursing facilities, 6.6% reduction in readmissions for all patients (regardless of location), and 34% relative improvement in communication about medications for patients at highest and high risk of mortality.

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