Mortality Review Committee: Understanding Inpatient and 30-Day Mortality at a Comprehensive Cancer Center.

Abstract

Background: The Triple Aim of health care involves the simultaneous pursuit of improving the individual experience of care, population health, and reducing per capita costs of care. Our institution established a Mortality Review Committee (MRC) to review instances of inpatient mortality as part of continuing quality improvement with the goal of improving goal concordant care. In this article, we report the experience of MRC. Measures/Interventions: In April 2022, an MRC was formed to evaluate inpatient and 30-day hospital mortality mortalities at our institution. The committee was formed with representation across the entire medical staff. The primary feature of each review was to characterize if the episode of care surrounding the mortality had a learning and/or improvement opportunity associated with the episode of care. Opportunities included improvements in documentation, communication between patients and/or care team, medically futile treatments or procedures, and consideration of interventions, adverse medical and surgical complications. Results: Patients with goals of care (GOC) discussion or palliative care visit prior to admission were significantly less likely to have a learning opportunity (29% vs. 51%, p < 0.001) and (37% vs. 48%, p < 0.001), respectively. The frequency of GOC conversations remained stable throughout the course of this intervention, although an increase in hospice referrals ensued. Discussion: The MRC promoted open conversation across an interdisciplinary team to understand how the health system could have better served patients who experienced hospital associated mortality. These meetings frequently gravitated toward documentation and communication with a particular focus on earlier GOC discussions and shared decision making across a patient's disease course. Our MRC committee has helped foster a cultural shift of the integration of advanced care/end of life planning at earlier stages of patients' treatment courses.