title: The Mortality Review Committee: a novel and scalable approach to reducing inpatient mortality.
abstract: BACKGROUND
  Despite the importance of reducing inpatient mortality, little has been reported about establishing a hospitalwide, systematic process to review and address inpatient deaths. In 2006 the University of Pennsylvania Health System's Mortality Review Committee was established and charged with reducing inpatient mortality as measured by the mortality index--observed/expected mortality.
  
  
  METHODS
  Between 2006 and 2012, through interdisciplinary meetings and analysis of administrative data and chart reviews, the Mortality Review Committee identified a number of opportunities for improvement in the quality of patient care. Several programmatic interventions, such as those aimed at improving sepsis and delirium recognition and management, were initiated through the committee.
  
  
  RESULTS
  During the committee's first six years of activity, the University HealthSystem Consortium (UHC) mortality index decreased from 1.08 to 0.53, with observed mortality decreasing from 2.45% to 1.62%. Interventions aimed at improving sepsis management implemented between 2007 and 2008 were associated with increases in severe sepsis survival from 40% to 56% and septic shock survival from 42% to 54%. The mortality index for sepsis decreased from 2.45 to 0.88. Efforts aimed at improving delirium management implemented between 2008 and 2009 were associated with an increase in the proportion of patients receiving a "timely" intervention from 18% to 57% and with a twofold increase in the percentage of patients discharged to home.
  
  
  CONCLUSIONS
  The establishment of a mortality review committee was associated with a significant reduction in the mortality index. Keys to success include interdisciplinary membership, partnerships with local providers, and a multipronged approach to identifying important clinical opportunities and to implementing effective interventions.
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
authors.forename: John S
authors.initials: JS
authors.lastname: Barbieri
authors.forename: Barry D
authors.initials: BD
authors.lastname: Fuchs
authors.forename: Neil
authors.initials: N
authors.lastname: Fishman
authors.forename: Carolyn Crane
authors.initials: CC
authors.lastname: Cutilli
authors.forename: Craig A
authors.initials: CA
authors.lastname: Umscheid
authors.forename: Craig
authors.initials: C
authors.lastname: Kean
authors.forename: Sherine
authors.initials: S
authors.lastname: Koshy
authors.forename: Patricia Garcia
authors.initials: PG
authors.lastname: Sullivan
authors.forename: P J
authors.initials: PJ
authors.lastname: Brennan
authors.forename: Rachel R
authors.initials: RR
authors.lastname: Kelz
mesh_terms: D000058:Accidental Falls / Q000401:mortality; D026683:Advisory Committees / Q000458:organization & administration*; D017028:Caregivers; D003142:Communication; D003693:Delirium / Q000401:mortality; D017051:Hospice Care; D017052:Hospital Mortality / Q000639:trends*; D006784:Hospitals, Teaching / Q000458:organization & administration*; D006801:Humans; D007256:Information Systems / Q000458:organization & administration; D017060:Patient Satisfaction; D010414:Pennsylvania; D058996:Quality Improvement / Q000458:organization & administration*; D019984:Quality Indicators, Health Care; D018805:Sepsis / Q000401:mortality