Improve Healthcare Quality Through Mortality Committee: Retrospective Analysis of Bambino Gesù Children Hospital’s Ten Years’ Experience 2008-2017

Abstract

Background: Healthcare quality improvements are one of the most important goals to reach a better and safer healthcare system. Reviewing in-hospital mortality data is useful to identify areas for improvement, and to monitor the impact of actions taken to avoid preventable cases, such as those related to healthcare associated infections (HAI). Methods: In this paper, we present the experience of the Mortality Committee of Bambino Gesù Children Hospital (OPBG). OPBG has instituted a process of systematic revision of all in-hospital deaths conducted by a multidisciplinary team. The goal is to identify system-wide issues that could be improved to reduce in-hospital preventable deaths. In this way, the mortality review goes alongside all the other risk management activities for the continuous quality improvement and patient safety. Results: In years 2008-2017, we performed a systematic analysis of 1148 inpatient deaths. In this time period, the overall mortality rate was 0.4%. Forty-seven deaths were caused due to infections, 10 of which involved patients with HAI transferred to OPBG from other facilities or patients with community- acquired infections. Six deaths related to HAI were followed by claims compensations. All these cases were not followed by compensation because the onset of HAI was considered an inevitable consequence of the underlying disease. Conclusion: Introduction of the mortality review committee has proved to be a valid instrument to improve the quality of the care provided in a hospital, allowing early identification of care gaps that could lead to an increase in mortality rates. Article Highlights Box: Reduction of preventable deaths is one of the most important goals to be achieved for any health-care system and to improve the quality of care. • Several studies have shown that analysis of morbidity and mortality rate helps to detect any factors that can lead to an increase in in-hospital mortality rates. • The review of in-hospital deaths allows to learn how to improve the quality and safety of care through identification of critical issues that lead to an increase in mortality ratio. • In some medical areas, such as intensive care units or surgery, the implementation of the conference on mortality and morbidity is more useful for assessing procedures at high risk of errors. • The implementation of existing databases with data deriving from the systematic review of medical records and in-hospital deaths appears to be desirable. • Mortality Review Committees can represent a very useful tool for all the health facilities for the reduction of preventable deaths, such as those related to HAI.

One health system’s morbidity and mortality conference survey: a step on the journey to organizational high reliability

“…In a separate Italian study, from 2008 to 2017, a pediatric hospital Mortality Committee performed a systematic analysis of 1148 inpatient deaths with an overall mortality rate of 0.4%. Although overall mortality did not decline, hospital acquired infection surfaced as a major—and actionable—cause of death 9 . A literature review of medical, surgical, and critical care M&M conferences identified 5 themes: defining the role of the M&M conference, involving stakeholders, detecting, and selecting appropriate cases for presentation, structured discussion, and follow-up on recommendations 14 . Interviews of faculty surgeons, residents, and physician assistants identified a number of elements thought important to a successful M&M conference, including availability of information, participant motivation, and realization processes 32 .…”

“…In a separate Italian study, from 2008 to 2017, a pediatric hospital Mortality Committee performed a systematic analysis of 1148 inpatient deaths with an overall mortality rate of 0.4%. Although overall mortality did not decline, hospital acquired infection surfaced as a major—and actionable—cause of death 9 .…”

“…Opportunities to reduce system wide-variations are another benefit [5][6][7] . A 100% mortality review may also help identify categories of harm and actionable themes [8][9][10][11] . Lastly, a 100% mortality review can be used to estimate preventable mortality [12][13][14][15] .…”

Implementation of Hospital Mortality Reviews: A Systematic Review

“…With respect to QI opportunities, that is, issues in quality and safety of patient care found and addressed through implementation of MRs, only one publication 26 did not report results. However, data on QI opportunities from the other publications differed in terms of assessment and detail reported.…”

Quality of inpatient care of small and sick newborns in Pakistan: perceptions of key stakeholders

“…In this regard, the hospital committee on mortality audit; a concept which is usually non-existent in public sector health care facilities in Pakistan, if gets instituted can prove to be highly beneficial. The committee can review in-hospital mortality data to examine the causes and impact of actions taken to avoid preventable mortality, such as those related to healthcare-associated infections (HAI) [42].…”