Eliminating preventable death at Ascension Health

Borgess Medical Center, the alpha site, developed innovative strategies to eliminate preventable deaths--one of Ascension Health's eight priorities for action. IMPLEMENTATION OF STRATEGIES: A multifocal approach included the intensivist and hospitalist models and six strategies, four in critical care and two outside critical care.

The results of one critical care strategy--tight glycemic control with insulin drips--and one non-critical care strategy--deploying rapid response teams--are reported for three periods: Period 1 (baseline; April 1, 2003-March 31, 2004), Period 2 (April 1, 2004-March 31, 2005), and Period 3 (April 1, 2005-March 31, 2006). Hyperglycemia (> 150 mg/dL) decreased from 48.12% to 37.18% (Period 2) and 25.08% (Period 3). Hypoglycemia (< 70 mg/dL), beginning at 1.64%, increased moderately, to 1.69% and 2.15%. Rapid response team calls per 1,000 discharges increased by 77.54% from Period 2 to Period 3--from 6.28 to 11.15. With an overall 25% reduction in mortality rate as a realistic expression of "eliminating preventable death" by 2008, observed mortality decreased during a two-year period by 19.2% (+/- 0.74%).

Decreases in mortality were accompanied by control of hyperglycemia in critical care and the implementation of rapid response teams to rescue patients before cardiopulmonary arrest outside of critical care. Most of the preventable deaths occurred among non-end-of-life-care patients and were associated with adverse events, which in most cases, had been identified within Ascension Health's priorities for action.