Becker's Clinical Quality & Infection Control

55 QUALITY IMPROVEMENT & MEASUREMENT Study: Reviewing ICU deaths can improve care quality By Mackenzie Bean Q uick, in-person meetings to review intensive care unit deaths can be an effective tool to improve care quality in the ICU, according to a study published March 1 in the American Journal of Critical Care. Clinicians at the Ronald Reagan University of California Los An- geles Medical Center piloted a multidisciplinary rapid mortality review process in 2013. e program entailed regular meetings in which staff members reviewed each patient death in the ICU and discussed whether the death could have been prevented or if any aspects of care could have been improved. Aer each meeting, a summary of the discussion was recorded in an electronic database so quality leaders could review the information and implement changes, as needed. By 2018, the hospital's rapid mortality review team had analyzed 542 patient deaths, 7 percent of which were deemed potentially avoid- able. Leaders identified issues in 54 percent of cases, ranging from communication problems and care delays to medical errors. ey also recommended action items aer reviewing 32 percent of cases. Nearly two-thirds of these action items — such as creating a stan- dardized checklist for inbound patient transfers — were completed, and 11 percent led to tangible systemic changes at the hospital. "Our findings suggest that these short and timely in-person meet- ings can be a powerful tool for efforts to both improve quality and prevent mortality in the ICU," lead author Kristin Schwab, MD, a pulmonologist and critical care physician at UCLA Health, said in a news release. "Bringing members of the multidisciplinary care team together for regular face-to-face discussions provided a forum that revealed concerns and solicited tangible ideas for solutions." n Intermountain builds calculator to identify potential high-risk COVID-19 patients By Jackie Drees S alt Lake City-based Intermountain Healthcare has embedded a risk calculator in its daily report of positive COVID-19 test results to determine which individuals are at high risk and need to receive an antibody treatment. Since the pandemic started, Intermountain has evaluated 125,000 individuals with COVID-19, according to a March 17 news release shared with Becker's Hospital Review. Data from those patients is synthesized and used across Intermountain to help inform best care practices, includ- ing identifying treatments that work best early on. "Advanced algorithms help frontline caregivers make clin- ical decisions based on modern machine learning meth- ods," Intermountain Assistant Vice President of Analytics Services Greg Nelson said in the news release. "These [AI] methods can significantly enhance the predictability of pa- tient outcomes and how we support personalized care." Intermountain's analytics tool have helped care managers from the health system's population health subsidiary Cas- tell proactively reach out by phone to patients who are not in the hospital and do not have COVID-19 but might be at risk of contracting the virus and having complications, due to other chronic conditions or comorbidities. The health system had contacted 1,500 at-risk patients through personal outreach as of March 17. Care man- agers teach these individuals how to reduce their risk of getting the virus and explain the importance of getting tested and treatments. n C-section rates still too high at many hospitals, Leapfrog says By Mackenzie Bean W hile hospitals have made progress in improving maternal care outcomes in two of three areas, there is more work to be done on reducing the number of cesarean sections, according to The Leapfrog Group's 2020 Maternity Care Report released April 8. For the report, Leapfrog assessed hospitals on cesarean sections, early elective deliveries and episiotomy rates. Leapfrog used 2020 survey data submitted by more than 2,200 hospitals nationwide for its analysis. Four takeaways: 1. Episiotomy rates decreased from 6.3 percent in 2019 to 5.2 percent in 2020, nearing Leapfrog's target of 5 per- cent or less. 2. The average rate of early elective deliveries was 1.6 per- cent in 2020, with 92 percent of hospitals meeting Leap- frog's standard of 5 percent or less for this metric. When Leapfrog released its first maternity care report in 2010, this rate was 17 percent. 3. A record 51 percent of hospitals met Leapfrog's C-sec- tion standard of 23.9 percent or less, up from 42 percent of hospitals in 2019. 4. Hospitals' average C-section rate was 24.5 percent in 2020, down slightly from 25.6 percent in 2019. Despite this progress, Leapfrog said average C-section rates are still too high and vary widely among states and hospitals in each state. n

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