title: Preventable mortality: does the perspective matter when determining preventability?
abstract: BACKGROUND
  We report a novel approach to mortality review using a 360° survey and a multidisciplinary mortality committee (MMC) to optimize efforts to improve inpatient care.
  
  
  METHODS
  In 2009, a 16-item, 360° compulsory quality improvement survey was implemented for mortality review. Descriptive statistics were performed to compare the responses by provider specialty, profession, and level of training using the Fisher exact and chi-square tests, as appropriate. We compared the agreement between the MMC review and provider-reported classification regarding the preventability of each death using the Cohen kappa coefficient. A qualitative review of 360° information was performed to identify the quality opportunities.
  
  
  RESULTS
  Completed surveys (n = 3095) were submitted for 1683 patients. The possibility of a preventable death was suggested in the 360° survey for 42 patients (1.40%). We identified 502 patients (29.83%) with completed 360° surveys who underwent MMC review. The inter-rater reliability between the provider opinions regarding preventable death and the MMC review was poor (kappa = 0.10, P < 0.001). Of the 42 cases identified by the 360° survey as preventable deaths, 15 underwent MMC review; 3 were classified as preventable and 12 were deemed unavoidable. Qualitative analyses of the 12 discrepancies did reveal quality issues; however, they were not deemed responsible for the patients' death.
  
  
  CONCLUSIONS
  The mortality survey yielded important information regarding inpatient deaths that historically was buried with the patient. Poor agreement between the 360° survey responses and an objective MMC review support the need to have a multipronged approach to evaluating inpatient mortality.
authors.affiliation: Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
authors.forename: Meera
authors.initials: M
authors.lastname: Gupta
authors.forename: Barry
authors.initials: B
authors.lastname: Fuchs
authors.forename: Carolyn
authors.initials: C
authors.lastname: Cutilli
authors.forename: Jessica
authors.initials: J
authors.lastname: Cintolo
authors.forename: Caroline
authors.initials: C
authors.lastname: Reinke
authors.forename: Craig
authors.initials: C
authors.lastname: Kean
authors.forename: Neil
authors.initials: N
authors.lastname: Fishman
authors.forename: Patricia
authors.initials: P
authors.lastname: Sullivan
authors.forename: Rachel R
authors.initials: RR
authors.lastname: Kelz
mesh_terms: D000046:Academic Medical Centers / Q000592:standards; D005260:Female; D019538:Health Care Surveys; D017052:Hospital Mortality; D006801:Humans; D007396:Internship and Residency / Q000592:standards; D008297:Male; D008505:Medical Staff, Hospital / Q000592:standards; D009722:Nurse Practitioners / Q000592:standards; D017063:Outcome Assessment, Health Care / Q000592:standards*; D010348:Patient Care Team / Q000592:standards; D010823:Physician Assistants / Q000592:standards; D011367:Professional Staff Committees / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000379:methods*; D012138:Respiratory Therapy / Q000592:standards; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000592:standards
keywords: 360° survey; Mortality review process; Multidisciplinary mortality review; Preventable mortality