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An Ounce of Prevention

Created Nov 13 2018, 01:28 PM by Lippincott Solutions
  • hospital-acquired conditions
  • mortality
  • patient safety
  • preventable illness

Preventable mortality refers to avoidable inpatient hospital deaths, i.e. deaths that are not the expected or probable outcome of a patient's hospital stay.

There is a growing recognition that organizational interventions to improve patient care planning can reduce preventable mortality occurrences.Some examples are as follows:

  • Enhanced communication among caregivers
  • Better initial assessment of patient fatality risk
  • Closer monitoring of deteriorating patient health
  • Adoption of evidence-based care practices and protocols.

Causes and Risk Factors

Among the leading diagnoses associated with high rates of inpatient mortality nationwide are respiratory failure, aspiration pneumonitis, cancer of the bronchus, and acute cerebrovascular disease.

Sepsis is also a leading cause of death in non-coronary care intensive care units in the U.S., with a mortality rate between 30% and 50%. Sepsis occurs when the immune system's reaction to an infection may injure body tissues far from the original infection. As sepsis progresses, it begins to affect organ function and eventually can lead to septic shock-- a potentially fatal drop in blood pressure.

Another leading cause of preventable patient death in hospitals is venous thromboembolism, or VTE blood clots. A study from the American Heart Association estimates 900,000 cases of VTE occur annually, leading to some 300,000 deaths.

There are two types of VTEs: deep-vein thrombosis (DVT), which occurs in a large vein, most often in the legs, and pulmonary embolism (PE), which is a blockage of the main artery of the lung via a blood clot. Although DVT is more common, most preventable deaths are caused by PE.

Preventing Problems

What's being done to reverse these mortality rates? There are a few ways that hospitals and their employees can dramatically reduce the occurrence of hospital-acquired VTE: improvement of the surgery procedure itself, better quality post-surgical medication, and more precise identification of higher-risk patients.

One possible way to reduce the potential for developing a blood clot is to reduce the incision size or invasiveness of a surgical procedural. Laparoscopic techniques reduce recovery time and minimize incision size. Traditional surgery has the potential to yield larger and less precise incision sizes, which can increase patients' chances for acquiring an infection or, even worse, developing a VTE.

After surgery is complete, one way to prevent clotting in patients is the use of a combination of compression stockings on the legs and blood-thinning medications. Of course, caution must be taken with blood thinners because anticoagulants can be just as dangerous with the potential of excessive bleeding.

Finally, recognize which patients are at higher risk for developing VTE. Patients who are predisposed to VTE are given ultrasounds if they're suspected of developing DVT, or a CT scan if they're suspected of developing PE.

The Takeaway

In working to reduce preventable mortality, the Massachusetts Hospital Association (MHA) offers programs to assist facilities in building effective hospital mortality review programs. Thisinitiative, called Mortality: Learning-in-Network (M-LiNk), also implements evidence-based strategies to reduce mortality for patients and conditions at greatest risk.

M-LiNk includes:

  • Learning series with experts on interventions associated with best practices for reducing hospital mortality rates
  • Website resources via PatientCareLink with tools and resources in key content areas
  • Virtual networking to foster inquiries, share resources, and promote learning across hospitals
  • Individualized technical assistance to support implementation of selected interventions
  • Communications via MHA's website to present case studies and highlight lessons learned.

For more resources on mortality reduction, you can access the American Hospital Association (AHA)'s Hospital Strategies for Reducing Mortality, part of its Hospitals in Pursuit of Excellence initiative.

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