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Inverse Probability of Treatment Weighting Propensity Score using the Military Health System Data Repository and National Death Index

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Development and Implementation of an Inpatient Mortality Review: a Feasibility Study.

Moritz S Schönfeld¹, Hans-Jürgen Bartz², Katrin Kokartis²

¹Department of Medical Psychology.

Journal of Patient Safety

|March 24, 2026

Summary

This summary is machine-generated.

Implementing a hospital-wide mortality review was feasible but faced organizational barriers. While potentially preventable deaths were identified, inter-rater agreement was low, requiring workflow adaptations for sustainable integration.

Keywords:

implementation science inpatient care mortality review patient safety quality of health care risk management

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Area of Science:

Healthcare Management
Patient Safety
Medical Informatics

Background:

Hospital-wide mortality review processes are vital for analyzing inpatient deaths and enhancing patient safety.
This study assessed the feasibility of implementing such a review in a German academic medical center.

Purpose of the Study:

To evaluate the feasibility and identify barriers and facilitators of a hospital-wide mortality review process.
To assess the usability and integration of a novel mortality review checklist into clinical systems.

Main Methods:

A mortality review checklist, based on the Harvard Mortality Review, was developed and pilot-tested.
The checklist was implemented hospital-wide over 12 months, with reviews conducted by attending physicians and clinical risk managers.
Evaluation involved clinical/administrative data and interviews to identify barriers and facilitators.

Main Results:

Physicians completed 37% of reviews, identifying 4.3% of deaths as potentially preventable; risk managers reviewed all deaths, identifying 2.5% as potentially preventable.
Nosocomial infections were the most frequent complication identified (35% physician, 33% risk manager).
Inter-rater agreement was poor to substantial, with low agreement on preventability; key barriers included limited physician resources and documentation redundancy.

Conclusions:

A hospital-wide mortality review is feasible but challenged by organizational barriers and low inter-rater agreement.
Sustainable integration requires significant adaptations to clinical workflows and organizational structures.
Structured mortality reviews can support learning from inpatient deaths as part of patient safety initiatives.