Rapid Mortality Review in the Intensive Care Unit: An In-Person, Multidisciplinary Improvement Initiative

Kristin E Schwab; Wendy Simon; Myrtle Yamamoto; Anna Dermenchyan; Xueqing Xu; Yuhan Kao; Alexander Zider; Faisal Shaikh; Bryan Garber; Elinor Lee; Zafia Anklesaria; G Sofia Nelson; Allison Ramsey; Thanh H Neville

doi:10.4037/ajcc2021829

Rapid Mortality Review in the Intensive Care Unit: An In-Person, Multidisciplinary Improvement Initiative

Am J Crit Care. 2021 Mar 1;30(2):e32-e38. doi: 10.4037/ajcc2021829.

Authors

Kristin E Schwab¹, Wendy Simon², Myrtle Yamamoto³, Anna Dermenchyan⁴, Xueqing Xu⁵, Yuhan Kao⁶, Alexander Zider⁷, Faisal Shaikh⁸, Bryan Garber⁹, Elinor Lee¹⁰, Zafia Anklesaria¹¹, G Sofia Nelson¹², Allison Ramsey¹³, Thanh H Neville¹⁴

Affiliations

¹ Kristin E. Schwab is clinical instructor, Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
² Wendy Simon is an associate clinical professor, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles.
³ Myrtle Yamamoto is nurse manager, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles.
⁴ Anna Dermenchyan is nurse manager, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles.
⁵ Xueqing Xu is a nursing unit manager, Department of Nursing, University of California, Los Angeles.
⁶ Yuhan Kao is a clinical nurse specialist, Department of Nursing, University of California, Los Angeles.
⁷ Alexander Zider is a pulmonologist, Pulmonary Associates, Burlingame, California.
⁸ Faisal Shaikh is a fellow, Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
⁹ Bryan Garber is a pulmonologist, Division of Pulmonary and Critical Care, Sansum Clinic, Santa Barbara, California.
¹⁰ Elinor Lee is clinical instructor, Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
¹¹ Zafia Anklesaria is a pulmonologist, Department of Pulmonary and Critical Care, California Hospital Medical Center, VEP Healthcare, Los Angeles, California.
¹² Sofia Nelson is a pulmonologist, West Coast Pulmonary & Critical Care Medicine, Oxnard, California.
¹³ Allison Ramsey is clinical instructor, Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
¹⁴ Thanh H. Neville is an assistant professor, Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.

PMID: 33644811
DOI: 10.4037/ajcc2021829

Abstract

Background: Significant resources have been allocated to decreasing the number of preventable deaths in hospitals, but identifying preventable factors and then leveraging them to effect system-wide change remains challenging.

Objective: To determine the ability of a novel in-person, multidisciplinary "rapid mortality review" process to identify deaths that are preventable and action items that lead to improvements in care.

Methods: Rapid mortality review sessions were conducted weekly for patients who died in the medical intensive care unit. Patient data and clinician opinions regarding preventable deaths were discussed and recorded. Bivariate analyses were done to detect associations between case variables and the formation of an action item.

Results: From 2013 to 2018, 542 patient deaths were reviewed; of those, 36 deaths (7%) were deemed potentially preventable. Facilitators identified issues in 294 cases (54%). A total of 253 action items were identified for 175 cases (32%); 60% of those action items were subsequently completed and led to tangible systemic change in 29 instances (11%). Action items were more likely to be identified for patients who had not been receiving comfort care (P < .001), for patients who had received cardiopulmonary resuscitation (P < .001), when the treatment team (P < .001) or the rapid mortality review facilitator (P < .001) had care-related concerns, and when the patient's death had been preventable (P < .001).

Conclusions: Even in settings with low reported rates of preventable deaths, an in-person multidisciplinary mortality review can successfully identify areas where care can be improved, leading to systemic change.

MeSH terms

Hospital Mortality*
Humans
Intensive Care Units*
Quality Assurance, Health Care