The mortality observed-to-expected ratio in otolaryngology

The mortality observed-to-expected (O:E) ratio is rapidly becoming the most important measured quality metric by allowing quantification and comparison of survival outcomes among different providers and institutions. Although the O:E ratio is monitored by external observers, the ratio is unfamiliar to individuals within most institutions.

Retrospective chart review.

Vanderbilt University Medical Center.

Twenty-eight patients cared for by the Department of Otolaryngology died while in the hospital between January 2001 and December 2010. All patient charts were reviewed for indicators related to mortality. From January 2006 to December 2010, a standardized mortality O:E ratio had been available using the All Patient Refined-Diagnosis Related Group (APR-DRG) grouper from the United Healthcare Consortium (UHC). The O:E ratio can be monitored over time to measure and quantify the effect of various interventions.

The otolaryngology O:E ratio quarterly results have varied from 1.1 to 0.29, based on a standard of 1.0. Internally, results have been primarily the result of mortalities of patients on the Head and Neck Service. Attention to common postoperative complications, accurate coding of comorbidities, and the compassionate use of palliative care consults have led to a significant decrease in the O:E ratio. Conversely, transfers from other hospitals have increased the ratio.

The Department of Otolaryngology has reduced the O:E ratio by focusing attention on factors that have been shown to reduce mortality and to enhance compassionate terminal care.