Becker's Clinical Quality & Infection Control

9 QUALITY IMPROVEMENT & MEASUREMENT Hospital mortality, infection rates improve despite rising acuity: 3 findings By Mackenzie Bean E ven as patient acuity climbed over the last several years, hospitals posted notable gains in mortality and reductions in two major hospital-acquired infections, a new Vizient report found. The Jan. 22 report is based on an analysis of the Vizient Clinical Data Base, which includes data from more than 1,000 hospitals nationwide. It compares trends from the fourth quarter of 2019 to the second quarter of 2025 across measures of acuity, mortality performance and select hospital-acquired infections. "These improvements occurred during a period marked by workforce shortages, supply chain instability and rising case complexity, signaling that the system's quality infrastructure is stronger, more adaptive and more scalable than often recognized," the report said Three notable findings: 1. Patient acuity increased 5% between 2019 and 2025, with hospitals' case mix index rising from 1.71 to 1.80. 2. The mortality index — which compares a hospital's observed to expected deaths — decreased 33%, from 0.97 in 2019 to 0.65 in 2025. This trend reflects hospitals' improvements in clinical reliability, care processes and operational discipline, according to the report. 3. The rate of catheter-associated urinary tract infections and central line-associated bloodstream infections per 1,000 cases declined by 23% and 22%, respectively. The gains come as health systems have worked to rebuild safety culture and reestablish quality routines disrupted during the pandemic. Vizient framed the improvements as evidence of a stronger quality infrastructure, but warned that staffing shortages will continue to lengthen wait times and delay diagnoses — pressures that could test whether hospitals can sustain progress as demand and case complexity rise. n Organizations should consider expanding remote monitoring capabilities and look to implementing automated follow-up systems to check in on patients aer their procedures, Ms. Lawday said. ese types of tools can help identify which patients need clinical intervention, with algorithms designed to route concerns to clinicians based on severity. Remote patient monitoring, in particular, can help patients manage their conditions between visits, enabling early intervention and potentially preventing emergency department visits, Dr. Armistead said. "A lot of the quality work has to happen in between visits" in the ambulatory space, she said. "e gaps that we need to close on this front is to break out of the mentality of care only being rendered at the time of the visit, and having mechanisms to be able to provide care and shore up quality between visits by leveraging technology — and our teams and the reimbursement models, of course, have to recognize that and help us be able to do that." Building internal governance as regulatory gaps persist Peter Pronovost, MD, chief quality and clinical transformation officer at Cleveland-based University Hospitals said the health system has implemented a standardized quality and safety program across all of its ambulatory sites to address broader gaps in regulatory oversight. e effort started by creating a management oversight committee responsible for defining quality and safety functions across all relevant domains, including medication safety, infection prevention, environmental safety and employee safety. is committee helped map out the functions for each domain, clarify governance structures and determine who is responsible for conducting audits at each site. e health system uses standardized self-assessments and auditing processes to maintain consistent quality and safety standards across its ambulatory footprint. University Hospitals' approach reflects a broader challenge facing large health systems as ambulatory care expands: an uneven regulatory landscape. While ASCs face oversight comparable to hospitals through CMS certification requirements, Dr. Pronvost said many other outpatient sites operate with significantly lighter regulatory frameworks. Physician office practices, urgent care centers and other ambulatory venues oen lack the external quality mandates that hospitals navigate, leaving systems to build their own governance structures. For other health systems looking to strengthen their ambulatory safety infrastructure, Dr. Pronovost said the starting point is having a complete picture of ambulatory operations — a level of visibility that many systems lack. "Systems have grown from acquisitions and oen, there may not be a single person who has an understanding of the entire portfolio," Dr. Pronovost said. He advises health systems to map their full ambulatory footprint — including physician practices, ASCs, home care sites — then examine governance structures to determine who is responsible for what at each site. "We have a really simple rule that says if you really want to have a management system, you have to be able to map board to bedside who are the main people over each of those units," Dr. Pronovost said. "Trying to reduce ambiguity about responsibility and roles as much as possible is going to do a lot to improve safety." n

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