Reducing In-Hospital Mortality: Strategies For Improved Patient Outcomes

Reducing in-hospital mortality is a critical quality and safety priority for hospitals worldwide. While most hospital deaths are not due to failures in care delivery, many are preventable. Hospitals have implemented various strategies to reduce mortality rates, including interdisciplinary care approaches, root cause analysis, structured mortality reviews, and quality improvement initiatives. Additionally, early identification of patients at high risk, improvements in treatments and care delivery, and the adoption of evidence-based practices are crucial in mitigating in-hospital mortality. Machine learning models have also been developed to predict in-hospital mortality at the time of patient admission.

Hospitals should implement a standardised mortality review process

Standardised mortality reviews can also help hospitals identify specific causes of death that can be targeted with initiatives for reduction. For instance, sepsis is the leading cause of death in non-coronary intensive care units, and hospitals can implement early warning systems and standardised treatment protocols to reduce sepsis-related mortality. Additionally, hospitals can improve their overall quality of care by adopting a culture of shared responsibility, where all healthcare providers are encouraged to activate rapid response teams when patients show signs of deterioration.

A structured mortality review process should include a case-by-case audit of patient deaths, considering factors such as documentation of end-of-life status, identification of patients expected to die, and the impact of organisational factors on mortality rates. Hospitals can also benefit from virtual networking and sharing resources with other healthcare institutions to learn from their successes and challenges in reducing mortality rates. By implementing these standardised mortality reviews and adopting evidence-based practices, hospitals can make significant strides in reducing preventable in-patient deaths and improving patient outcomes.

Moreover, hospitals can utilise data-driven approaches to reduce mortality rates by monitoring mortality data over time and sharing best practices across their health systems. Electronic health records (EHR) can be powerful tools in this regard, helping to standardise best practices and identify patients at risk of deterioration. For instance, the deterioration index and sepsis alert within EHR systems can assist healthcare providers in providing timely interventions. By embracing data-driven strategies and learning from each other, hospitals can collectively improve their quality of care and patient safety.

Improve patient care planning and enhance communication between caregivers

Improving patient care planning and enhancing communication between caregivers are crucial steps in reducing in-hospital mortality. Care planning is a dynamic process that involves ongoing conversations and engagement with patients, beyond the initial development of the plan. It is a collaborative effort between nurses, patients, and other healthcare providers, and it ensures that the patient's needs, wants, and interventions are documented and addressed. Here are some key aspects to consider:

Patient-Centered Care Planning:

• Individualized Care: A patient-centered care plan considers the patient's unique needs, preferences, and values. It empowers patients by involving them in decision-making, improving their experience and satisfaction with the care they receive.
• Preventive Care: Patient-centered care plans facilitate preventive care services such as screenings, vaccines, and medication reviews, which can positively impact the patient's overall health and any existing conditions.
• Timely Interventions: By creating a patient-centered care plan, providers can enhance engagement and deliver timely interventions. The plan serves as a roadmap to coordinate treatments, care services, and goals, ensuring that interventions are aligned with the patient's goals and desired outcomes.

Enhancing Communication between Caregivers:

• Active Listening: Caregivers should prioritize listening to patients, family members, and other caregivers. Active listening fosters empathy, builds trust, and helps caregivers understand the unique situations and needs of those they care for.
• Non-Verbal Cues: Caregivers should be attentive to non-verbal cues, such as facial expressions and body language, which can provide valuable insights into how a patient is feeling, even when they may not express it verbally.
• Assertiveness and Honesty: Assertive and honest communication is essential in caregiver-patient relationships. Caregivers should advocate for what they believe is right for the patient's well-being while ensuring open and transparent dialogue.
• Collaboration: Effective communication between caregivers and within healthcare teams improves collaboration and coordination. This includes sharing information, opinions, and best practices to provide holistic care that addresses the physical, psychological, social, and spiritual needs of the patient.
• Appreciation: Expressing appreciation and recognizing the efforts of healthcare team members fosters a positive work environment and strengthens relationships, ultimately contributing to improved patient care.

By implementing these strategies, hospitals can improve patient care planning and enhance communication between caregivers, ultimately contributing to reduced in-hospital mortality rates and improved patient outcomes.

Hospitals should adopt evidence-based practices and protocols

One example of an evidence-based practice is the early activation of rapid response teams when patients begin to deteriorate. This practice has been shown to significantly reduce mortality rates. It involves healthcare providers recognising the signs of deterioration and immediately calling for a response team, rather than attempting to manage the situation alone. This promotes a culture of shared responsibility and improves the timeliness and effectiveness of critical interventions.

Another example is the use of data and electronic health records to drive improvement. Hospitals can monitor mortality data over time, identify areas of concern, and implement targeted interventions. Electronic health records can also be utilised to standardise best practices and improve communication between healthcare providers, ensuring consistent and high-quality care for all patients.

Additionally, hospitals can adopt evidence-based protocols for specific conditions with high mortality rates, such as sepsis. Sepsis is a life-threatening condition that requires prompt recognition and treatment. By implementing evidence-based protocols for sepsis, including early identification, appropriate antimicrobial therapy, and supportive care, hospitals can significantly improve patient outcomes and reduce mortality associated with this condition.

Furthermore, hospitals can benefit from participating in learning networks and collaborative initiatives focused on mortality reduction. These networks provide opportunities for hospitals to share best practices, learn from each other's successes and failures, and implement evidence-based strategies that have proven effective in similar settings. By adopting a culture of continuous improvement and utilising data-driven approaches, hospitals can make significant strides in reducing in-hospital mortality and enhancing patient safety.

Hospitals should improve medication safety

Firstly, hospitals should focus on the 5 Moments for Medication Safety, a patient engagement tool developed by the WHO. This tool aims to empower patients, their families, and caregivers to take an active role in ensuring safer medication practices. It outlines five key moments where action can reduce the risk of harm associated with medication use, and can be applied in collaboration with health professionals at different levels and contexts of care.

Secondly, hospitals should encourage a culture of safety and accountability, where medication errors are reported and addressed without fear of retribution. Confidential reporting options are necessary to identify system deficiencies and failures, and to develop corrective measures. For example, an electronic medical record "stop alert" can be implemented to prevent errors from reoccurring, as well as providing training and education on drug interactions to all medical staff.

Thirdly, hospitals should improve communication and collaboration between primary and secondary care providers. Discharge letters and patient records should be revised to highlight any changes in medications, and electronic systems can facilitate access to accurate and up-to-date medication information.

Finally, hospitals should prioritize patient education and engagement regarding medication safety. Patients and their caregivers should be involved in their care and empowered to ask questions and seek clarification about their medications. This includes prescription, preparation, dispensing, administration, and monitoring. By involving patients in their medication management, hospitals can reduce the risk of medication errors and improve overall patient safety.

By implementing these strategies, hospitals can significantly improve medication safety, reduce medication-related harm, and ultimately decrease in-hospital mortality rates.

Hospitals should improve hygiene, cleanliness, air quality and wound care

Hospitals should improve hygiene, cleanliness, air quality, and wound care to reduce in-hospital mortality.

Hygiene and cleanliness are critical factors in reducing hospital-acquired infections, which are a leading cause of illness and death in hospitals. Hospitals can implement targeted cleaning strategies, such as environmental cleaning bundles, to improve hygiene and reduce contamination and infection risks. This includes cleaning and disinfecting hard surfaces and high-touch objects in hospital rooms, using appropriate technologies, and adopting hand hygiene practices. Standard thresholds for defining cleanliness and monitoring strategies are also essential to ensure effective sanitation.

Air quality is another important consideration for hospitals. Poor air quality can lead to adverse health effects, including hospitalizations and even mortality. By improving air quality, hospitals can reduce their spending and the burden on insurance companies and employers. While there is limited research on the financing of pollution-related healthcare, studies suggest that meeting federal clean air standards can benefit stakeholders of public programs and private health insurers.

Wound care is a significant aspect of hospital care, impacting patients' quality of life and healthcare costs. Efficient wound management can reduce costs associated with nursing time, hospital stays, and dressings consumed. Advanced technology for rapid wound healing can minimize these costs, while also addressing the physical, mental, and social consequences of wounds. Additionally, understanding the principles of health economics in wound management can help optimize resources and improve efficiency in wound care delivery.

Furthermore, hospitals can adopt a multifaceted approach to reduce in-hospital mortality. This includes good leadership, accurate information, quality improvement strategies, and community engagement. By addressing gaps in communication, medication errors, and infection control, hospitals can enhance patient safety and provide high-quality care, ultimately reducing mortality rates.

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