Preventable mortality evaluation in the ICU

Abstract

Mortality is the most widely measured outcome parameter. Improvement of this outcome parameter in critical care is nowadays expected not to come from new technologies or treatment, but from delivering the right care at the right moment in a safe way. The measurement of mortality as an outcome parameter confronts us with a problem in providing follow-up to the results. Especially when proven structure and process interventions are applied already, the cause of a suboptimal performance cannot be deduced easily. One possibility is to evaluate the causes of death and to judge preventability. In this article we explore the opportunities and difficulties of a tool to evaluate preventable mortality in the ICU.

Potentially preventable deaths in the Victorian Audit of Surgical Mortality

“…Admission status, delays in patient care, requirement for critical care, the number of operations performed during the admission and presence of clinical management issues have all been identified as preventable issues associated with surgical care in previous reports. [2][3][4][8][9][10][11][12][13][14] These studies have focussed upon the preventability of the individual clinical management issues instead of our methodology, which provides a more holistic approach to the audit of the mortality. The VASM has previously shown that assessors found that inappropriate absence of either venous thromboprophylaxis or critical care unit use were not significant issues (only 6 and 8%, respectively, would have benefited), which emphasizes the importance of clinical management issues rather than risk management issues when examining surgical mortality.…”

“…There is a subtle but important difference in preventability of individual management issues that might be responsible for the death of a patient, which is the usual approach in the ANZASM audits, as opposed to issues identified in a mortality identified as potentially preventable. Admission status, delays in patient care, requirement for critical care, the number of operations performed during the admission and presence of clinical management issues have all been identified as preventable issues associated with surgical care in previous reports . These studies have focussed upon the preventability of the individual clinical management issues instead of our methodology, which provides a more holistic approach to the audit of the mortality.…”

Potentially Preventable Mortality in the Pediatric Intensive Care Unit: Findings from a Retrospective Mortality Analysis

“…They were trained, qualified pediatricians despite not being primarily responsible for direct patient care during the study period. Following the approach of Dijkema et al, we labeled preventability as "an event [mortality in our study] that would not have occurred if the patient had received ordinary standards of care appropriate for the time of study" [12]. Standard of care was defined as accepted patient care by an average practitioner using currently available evidence.…”

Real-time information on preventable death provided by email from frontline intensivists: results in high response rates with useful information

“…A quick and efficient method with high response rates from frontline providers is feasible and may provide useful information for quality improvement 4. However, large interindividual variations in response and judgement exist, and, therefore, this method apparently is insufficient for benchmarking.…”