Institute for Healthcare Improvement: Innovation Community: Reducing Mortality Rates (HSMR)

Overview

Innovation Communities are groups of improvement-minded organizations working together and with IHI to explore new designs and novel solutions to improve care where best practices do not already exist or are not fully developed. Projects last for approximately 10 months under the guidance of an IHI panel of experts, and are open to IMPACT member organizations only.

The Problem

The Solution

That patients die every day in hospitals is an accepted fact of medical care delivery.

What are not acceptable, however, are significant and unpredictable variations in death rates across the health care system.

IHI’s analysis of year 2000 Medicare data, appropriately adjusted for multiple variables such as population characteristics and diagnoses, has revealed that there is a 450 percent variation in standardized hospital death rates among U.S. hospitals. Which hospital a patient enters is highly correlated with the patient’s chance of dying.

Many of these deaths could be prevented if all the factors that contribute to them are better understood. As in most improvement efforts, a hospital whose aim is to prevent avoidable deaths must begin with the collection and analysis of data.

Hospital death rates, also referred to as hospital standardized mortality ratios (HSMR), can serve as important quality indicators, and are an essential starting point in a journey to improve care and reduce mortality.

As part of its effort to foster improvement in health care systems, IHI has developed an analytical tool for understanding hospital mortality rates, and an action framework designed to reduce deaths.

Areas of Focus

This Innovation Community will be a continuation of learning from initial testing of an analytical framework that places hospital deaths into four categories, each of which have associated strategies for improvement:


	ICU	NON-ICU CARE

COMFORT CARE ONLY	Strategy: Clarity of ICU admission/transfer criteria	Strategies: Advance Directives Alternatives to hospital care at the end of life Palliative Care Team Infrastructure Changes: Advanced directives completed pre-hospital In-house hospice program

NOT COMFORT CARE ONLY	Strategies: Multidisciplinary rounds and daily goals Ventilator bundle Tight glucose control Infrastructure Change: Intensivist program	Strategies: Rapid Response Team Reduction of adverse events Communication and teamwork techniques — SBAR Infrastructure Change: Hospitalist program

Aims

Participants will aim to make measurable improvements in each of the boxes. Overall outcome measures will be emphasized to reduce overall HSMR:

20 point reduction of overall HSMR or greater than 25% reduction in raw mortality
Reduction in box-specific mortality rates

To Participate

To join an Innovation Community, you must be a member of IHI's IMPACT network. See IMPACT Network for more details about this exciting network of organizations collaborating for results.