Quality improvement through review of inpatient deaths

Emphasis on hospital mortality as a monitoring tool has raised concerns about the validity of mortality rates as a measure of quality of care. An indepth review of all mortalities at Beth Israel Medical Center was conducted from 1988 through 1993. Clinical issues identified from chart review were referred for departmental physician peer review, and quarterly reports of trends and issues were disseminated to all levels of the institution. Mortality rates declined 21% over the 6 years, from 3.3% to 2.6% of all discharges. Clinical quality issues were identified in less than 3% of all mortalities. The majority of problems were related to delays and appropriateness of treatment (57% of quality issues). The review program identified specific hospital processes for improvement, and, more importantly, created a "watchful concern" about quality-of-care issues throughout the hospital.