The mortality review committee: A novel and scalable approach to reducing inpatient mortality

Joint Commission Journal on Quality and Patient Safety

Volumn 39, Issue 9, 2013, Pages 387-395

  Barbieri, John S ^a   Fuchs, Barry D ^a,b,c   Fishman, Neil ^c   Cutilli, Carolyn Crane ^c   Umscheid, Craig A ^d,e   Kean, Craig ^c   Koshy, Sherine ^f   Sullivan, Patricia Garcia ^c   Brennan, P J ^c   Kelz, Rachel R ^a,e  

^a UNIVERSITY OF PENNSYLVANIA   (United States)

^b HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA   (United States)

^c UNIVERSITY OF PENNSYLVANIA   (United States)

^d Center for Evidence Based Practice   (United States)

^e UNIVERSITY OF PENNSYLVANIA   (United States)

^f PENN PRESBYTERIAN MEDICAL CENTER   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ADVISORY COMMITTEE; CAREGIVER; DELIRIUM; FALLING; HEALTH CARE QUALITY; HOSPICE CARE; HUMAN; INFORMATION SYSTEM; INTERPERSONAL COMMUNICATION; MORTALITY; ORGANIZATION AND MANAGEMENT; PATIENT SATISFACTION; SEPSIS; TEACHING HOSPITAL; TOTAL QUALITY MANAGEMENT; TRENDS; UNITED STATES; ARTICLE;

ACCIDENTAL FALLS; ADVISORY COMMITTEES; CAREGIVERS; COMMUNICATION; DELIRIUM; HOSPICE CARE; HOSPITAL MORTALITY; HOSPITALS, TEACHING; HUMANS; INFORMATION SYSTEMS; PATIENT SATISFACTION; PENNSYLVANIA; QUALITY IMPROVEMENT; QUALITY INDICATORS, HEALTH CARE; SEPSIS;

EID: 84883015946     PISSN: 15537250     EISSN: None     Source Type: Journal    
DOI: 10.1016/s1553-7250(13)39052-7     Document Type: Review

References (29)

1. Institute of Medicine: To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press, 2000.
2. Wachter RM. Patient safety at ten: Unmistakable progress, troubling gaps. Health Aff (Millwood). 2010;29(1):165-173.
3. Murphy J, et al. Methodology: U.S. News & World Report Best Hospitals 2011-12. Jul 19, 2011. Accessed Jul 21, 2013. http://static.usnews.com /documents/health/best-hospitals-methodology.pdf.
4. US Agency for Healthcare Research and Quality (AHRQ). Guide to Inpatient Quality Indicators: Quality of Care in Hospitals-Volume, Mortality, and Utilization. Jun 2002. Version 3.1. (Updated: Mar 12, 2007.) Accessed Jul 21, 2013. http://www.qualityindicators.ahrq.gov/Downloads/Modules/IQI/V31 /iqi-guide-v31.pdf.
5. US Agency for Healthcare Research and Quality. Fact Sheet: Databases and Related Tools From the Healthcare Cost and Utilization Project (HCUP). Accessed Jul 21, 2013. http://www.ahrq.gov/data/hcup/datahcup.pdf.
6. Ferris TG, Torchiana DF. Public release of clinical outcomes data-Online CABG report cards. N Engl J Med. 2010 Oct 21;363(17):1593-1595.
7. Hospital Compare. Accessed Jul 21, 2013. http://www.hospitalcompare .hhs.gov/.
8. Orlander JD, Barber TW, Fincke BG. The morbidity and mortality conference: The delicate nature of learning from error. Acad Med. 2002;77(10): 1001-1006. (Pubitemid 35155226)
9. Lau H, Litman KC. Saving lives by studying deaths: Using standardized mortality reviews to improve inpatient safety. Jt Comm J Qual Patient Saf. 2011;37(9):400-408.
10. Wachter's World. How UCSF's Root Cause Analysis Process Became Our Most Useful Patient Safety Activity. Wachter RM. Dec 17, 2009. Accessed Jul 21, 2013. http://community.the-hospitalist.org/blogs/wachters-world /archive/2009/12/17/ how-ucsf-s-root-cause-analysis-process-became-our-most -useful-patient-safety- activity.aspx.
11. Personal communication between the author and Richard L. Simmons, MD, Co-director, University of Pittsburgh Medical Center, Pittsburgh, Aug 4, 2010.
12. University HealthSystem Consortium. Home page. Accessed Jul 21, 2013. https://www.uhc.edu/.
13. US Agency for Healthcare Research and Quality. Mortality Measurement: Mortality Risk Adjustment Methodology for University Health System [sic] Consortium. Meurer S. Mar 2009. Accessed Jul 21, 2013. http://www.ahrq.gov /professionals/quality-patient-safety/quality-resources/tools /mortality/Meurer.html.
14. Vermeulen LC, Windisch PA. Can administrative database studies inform medication use policy decisions? An application of Occam's razor. Am J Manag Care. 2001;7(1):89-90. (Pubitemid 32123734)
15. Iezzoni LI. Assessing quality using administrative data. Ann Intern Med. 1997 Oct 15;127(8 Pt 2):666-674.
16. Scinto JD, Sherwin TE, Fowler J. Use of Administrative Data in Measuring Quality of Care. Prepared for the Rhode Island Department of Health. Wethersfield, CT: Qualidigm, Aug 2000.
17. Cassel JB, et al. Hospital mortality rates: How is palliative care taken into account? J Pain Symptom Manage. 2010;40(6):914-925.
18. Goodpasture H, et al. Miscoding as a cause of elevated simple pneumonia mortality. Jt Comm J Qual Saf. 2004;30(6):335-341.
19. Miller RH, et al. The value of electronic health records in solo or small group practices. Health Aff (Millwood). 2005;24(5):1127-1137. (Pubitemid 41577100)
20. Miller RH, Sim I. Physicians' use of electronic medical records: Barriers and solutions. Health Aff (Millwood). 2004;23(2):116-126. (Pubitemid 38471048)
21. Gupta M, et al. Preventable mortality: Does the perspective matter when determining preventability? J Surg Res. Epub 2013 Jun 10.
22. University HealthSystem Consortium (UHC). Improving Survival 2006 Field Book. Oak Brook, IL: UHC, 2006.
23. Rivers E, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001 Nov 8;345(19):1368-1377.
24. Umscheid CA, Williams K, Brennan PJ. Hospital-based comparative effectiveness centers: Translating research into practice to improve the quality, safety and value of patient care. J Gen Intern Med. 2010;25(12):1352-1355.
25. Sessler CN, et al. The Richmond Agitation-Sedation Scale: Validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med. 2002 Nov 15;166(10):1338-1344. (Pubitemid 35292699)
26. Sarani B, et al. Improving sepsis care through systems change: The impact of a medical emergency team. Jt Comm J Qual Patient Saf. 2008;34(3):179-182.
27. Borzecki AM, et al. How valid is the AHRQ Patient Safety Indicator "postoperative physiologic and metabolic derangement"? J Am Coll Surg. 2011;212(6):968-976.e1-2.
28. Khuri SF, Daley J, Henderson WG. The comparative assessment and improvement of quality of surgical care in the Department of Veterans Affairs. Arch Surg. 2002;137(1):20-27. (Pubitemid 34041814)
29. Resar RK, et al. A trigger tool to identify adverse events in the intensive care unit. Jt Comm J Qual Patient Saf. 2006;32(10):585-590.