Beth Israel Deaconess Medical Center among the first-ever awardees in the National Awards Program to Recognize Progress in Eliminating Healthcare-Associated Infections CDC: Hospitals continue progress in preventing infections American Heart Association: Improvements in Door-to-Balloon Time in the US - 2005 to 2010 Thomson Reuters Top 10 Health Systems of 2011 UMass Memorial Diabetes Scorecard Cooley Dickinson Hospital: Better-than-National Infection Rate Drops Further Following UV Room Disinfection Mercy Medical Center, Implements a Program to Decrease Pressure Ulcers Lawrence General Hospital: Runner Up: Med/surg unit boosts safety and satisfaction with initiative care MetroWest Medical Center Demystifies Outpatient Satisfaction Partners Study on Falls Featured in JAMA Winchester Hospital: A Focus on Outcomes Southcoast Health System: Reducing the Use of Safety Sitters Partners: Coordinating Care for High-Risk Patients New Bedford Rehab's use of volumetric capnography Winchester Hospital -- Reducing IV-associated bloodstream infection Newton-Wellesley Hospital: eMAP Rx for Medication Errors? Reducing Surgical Site Infections at New England Baptist Hospital Milton Hospital Reduces Catheter-Associated Urinary Tract Infections Cooley Dickinson Hospital's Positive Culture Led to Pressure Ulcer Improvements Beverly Hospital Implements Nurse-Led Program to Reduce Patient Falls Boston Medical Center Nurses Teach Pressure Ulcer Prevention Two Hospitals are Co-Winners of Betsy Lehman Patient Safety Award Making Strides at Jordan Hospital to Reduce Falls Telling Your Hospital's Story Public Reporting of Serious Reportable Events Winchester Hospital's Hand-Hygiene Competency

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Definition
Preventable mortality refers to avoidable inpatient hospital deaths, those that are not an expected or probable outcome of a patient's hospital stay. There is a growing recognition that organizational interventions to improve patient care planning, enhance communication among caregivers, better asses patient risk of death, better respond to signals of deteriorating patient health, and adoption of evidence-based care practices and protocols can reduce preventable deaths.

What are the Causes and Risk Factors?
Sepsis is the leading cause of death in non-coronary care intensive care units in the United Sates, with a mortality rate between 30% and 50% (Surviving Sepsis Campaign, 2008). Sepsis occurs when the immune system's reaction to an infection may injure body tissues far from the original infection. As sepsis progresses, it begins to affect organ function and eventually can lead to septic shock - a sometimes fatal drop in blood pressure. The leading principal diagnosis for inpatient deaths in U.S. hospitals in 2007 was septicemia, the principal diagnosis in 15 percent of deaths (AHRQ Statistical Brief #81 rev. April 2010) In Massachusetts, deaths (1,954) of patients who developed sepsis after admission to the hospital accounted for 12.1 percent of all in-hospital deaths in FY 2009, resulting in 20.8-day hospital average length of stay and $82,553 average cost per case (MA DHCFP acute care hospital discharge database for FY 2009, analysis from the MA Health Data Consortium).

Other leading diagnoses associated with high rates of inpatient deaths nationwide are respiratory failure (17 percent death rate, 9 percent of deaths), aspiration pneumonitis (13 percent death rate, 3 percent of deaths), cancer of the bronchus (11 percent death rate, 2 percent of deaths) and acute cerebrovascular disease (9 percent death rate, 6 percent of deaths). Seventy-two percent of patients that died were emergency admissions and 73 percent had one or more procedures during the hospital stay (AHRQ Statistical Brief #81 rev. April 2010).

What's At Stake?
Thirty-two percent of all deaths in the U.S.in 2007 were inpatient hospital deaths. Hospital stays ending in death were responsible for 5.1 percent ($17.6 billion) of all hospital inpatient costs, an average of $26,035 per patient, which was 2.8 times higher than the average for patients discharged alive.

Note that this accounting of the frequency and costs of in-hospital deaths cannot distinguish preventable deaths from those that are not preventable.

What Can Hospitals Do to Reduce Preventable Mortality?
MHA is developing programming to assist hospitals in building an effective hospital mortality review program and implementing evidence-based strategies to reduce mortality for those patients and conditions at greatest risk. This initiative is called Mortality: Learning-in-Network (M-LiNk).

M-LiNk will include:

  • Learning series with local/national expertise on interventions associated with best practice for reducing hospital mortality rates;
  • Website resources via PatientCareLink with tools & resources in key content areas;
  • Virtual networking to foster inquiries, share resources, and promote learning across hospitals;
  • Individualized technical assistance to support implementation of selected interventions; and
  • Communications via MHA's website and Issues Briefs to present case studies and highlight lessons learned.

See the sidebar link to information on M-LiNk and AIMS: The Assessment of Improvement Methodology of Sepsis. 
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WORKING TO REDUCE PREVENTABLE MORTALITY: A Resource You Can Use

As part of its Hospitals in Pursuit of Excellence initiative, the American Hospital Association recently released Hospital Strategies for Reducing Mortality, providing a broad overview of key steps that hospital and health system leaders may take in developing a strategy for reducing preventable in-patient deaths. The publication also includes a list of resources available to help hospitals and health systems reduce mortality.

INVITATION TO PARTICIPATE IN MORTALITY: LEARNING-in-NETWORK (M-LiNk)

The Massachusetts Hospital Association (MHA) is pleased to announce the launch of Mortality: Learning-in-Network (M-LiNk), a learning series to address Hospital Mortality. 

M-LiNk will promote a series of
MHA- and locally-sponsored educational offerings and related programs focused on reducing hospital mortality.  M-LiNk will provide access to faculty experts, evidence-based interventions and local best practices to improve
related structures, processes and outcomes.  The sessions will be hosted as a combination of in-person meetings in various locations around the Commonwealth, in addition to virtual webinar events.

Our next session will be a conference held on September 8, 2011, entitled "Gain Full Value From Your Root Cause Analysis Investigations."  This full-day event is co-sponsored by  the Board of Registration in Medicine, Quality and Patient Safety Division; the Massachusetts Society for Healthcare Risk Management; the Massachusetts Hospital Association; and the Massachusetts Medical Society. Click here for more information.

See the sidebar to the left for more information on M-LiNk offerings. 

Please contact MHA's Pat Noga, Vice President of Clinical Affairs at PNoga@mhalink.org or (781) 262-6045 with any questions.