Improving the mortality index among gynecologic oncology patients

Background: The mortality index is a quality metric that measures the ratio of observed mortality to expected mortality among inpatients. Expected mortality is a probability calculation based on documentation of patient risks and comorbidities. A mortality index of <1.0 represents fewer patients dying while admitted to the hospital than expected. We aimed to decrease the mortality index in our department by 10% in 6 months. Methods: We formed a multidisciplinary team from Gynecologic Oncology, Health Coding and Institutional Compliance. We educated providers on documentation of patient comorbidities, standardized documentation templates, focused coder analysis and in-depth review and discussion as a department of all inpatient deaths. Pre-intervention 8/2017???7/2018 and post-intervention 11/2018???2/2020 outcomes were compared using the Mann Whitney U test. Results: The median mortality index decreased by 44% from 0.84 to 0.47 (p = 0.03). The median expected mortality increased by 37% from 2.94 to 4.02 (p = 0.002). The median number of inpatient deaths, or observed mortalities, was unchanged though there was a non-significant decreasing trend. Conclusions: Inpatient mortality index is an important quality metric that can be improved through education, standardized documentation, focused review and discussion of all inpatient mortalities.