Surgical mortality review reduces preventable deaths and patient safety indicators (PSIs)

Abstract

Financial penalty for unacceptable rates of mortality and Patient Safety Indicators (PSIs) is the reality of external quality management. Review of hospital deaths have shown a decrease in mortality ratios, but there are little data evaluating the long-term viability and results of these programs. Methods: From 1/2013 through 8/2014, 26,699 inpatients were cared for on 12 surgical services. A surgeon from each service led reviews of all mortality and PSIs with central reporting of preventability. We compared the proportion of preventable mortality, PSIs and the UHC Observed to Expected Mortality ratio (O:E ratio) over time. Statistical significance was p<0.05 by Poisson regression. Results: Of the 26,699 inpatients in the study period, there were 510 deaths (1.9%) and 553 PSIs (2%) reviewed. Of the 510 deaths, 137 were categorized as possibly preventable or preventable. The odds ratio of a preventable mortality was half in the final quarter compared to the first quarter and this reduction was primarily seen in high-risk services (p<0.05). The proportion of preventable PSIs fell from 70% to 26% during the same time period (p<0.05). The O:E ratio was consistently below 1(less deaths than expected) and fell throughout the study period (p<0.05). Conclusions: The improvement in the O:E ratio previously seen with hospital mortality review is a sustainable process. With a long-term commitment, the additional benefits are a reduction in preventable mortality and PSIs, especially in high-risk services. This process is one component that improves outcomes and reduces patient mortality.