The hospital mortality rate refers to the overall number of deaths in a hospital during a particular time frame. It can serve as an important quality indicator and is an essential starting point on the journey to improve care and reduce mortality. Mortality reduction is the process of decreasing the hospital mortality rate by improving the application of evidence- based interventions that can reduce avoidable deaths. The mortality rate can be tracked through use of the hospital’s risk-adjusted mortality rate (HSMR). HSMR is an accurate way to report mortality, as it reflects the ratio of actual deaths to the number of expected deaths, multiplied by 100. Another way to report the mortality is using the “Mortality Index” – the ratio of observed mortality to expected mortality. Lower mortality rates are reflected with results less than 1.0.
In 2006, Baystate Medical Center partnered with the IHI’s IMPACT Improvement Community for “Improving Outcomes for High-Risk and Critically Ill Patients” to launch our initial work on reducing mortality. After baseline analysis on avoidable deaths, clinical areas were identified for improvement, and using Plan-Do-Study-Act rapid cycle methods, interventions were put in place or are in the process of being finalized for implementation.
Clinical areas included:
- reducing and preventing central line-related bloodstream infections
- ventilator-associated pneumonia and surgical complications
- implementing the Early Warning Systems (EWS/PEWS) using our clinical information system
- implementing a staff and family activated Rapid Response Team (Adult and Pediatric)
- screening for early sepsis
- providing tighter glycemic control hospital-wide
- adopting a standardized communication tool (SBAR)