A Pragmatic Method for Measuring Inpatient Complications and Complication-Specific Mortality

Area of Science:

• Healthcare quality improvement
• Patient safety
• Hospital performance metrics

Background:

• Existing metrics for hospital-acquired complications and failure to rescue have limitations.
• There is a need for enhanced hospital-level metrics to identify specific areas for improvement.
• Current measures may not adequately capture the nuances of serious complications and associated mortality.

Purpose of the Study:

• To develop hospital-level metrics for major complications associated with mortality.
• To improve the identification of opportunities for enhancing patient care.
• To refine metrics for failure to rescue, defined as death from serious but treatable complications.

Main Methods:

• Utilized Agency for Healthcare Research and Quality metrics as a foundation.
• Calculated complication-specific occurrence and mortality rates using International Classification of Disease, Tenth Revision codes.
• Analyzed data for adult patients over four years, excluding hospice and admission complications, comparing the study institution with 182 peers.

Main Results:

• The complication-specific method revealed statistically significant differences in occurrence and mortality rates at the study hospital compared to peers.
• Monthly control charts demonstrated the effectiveness of hospital-level interventions in preventing complications and reducing failure to rescue deaths.
• Temporal visualizations facilitated comparison of past and recent performance against peer institutions.

Conclusions:

• The developed method enhances visualization of opportunities to improve care delivery systems by supplementing existing complication metrics.
• This approach minimizes reporting burden by leveraging existing measure components.
• Monthly time-series data enable rapid assessment of interventions aimed at preventing complications and improving patient rescue outcomes.