165 Institutional Review of Mortality in 5434 Consecutive Neurosurgery Patients

Abstract

Abstract INTRODUCTION In neurosurgery, increasing efforts have been employed to improve documentation and clinical outcomes including reducing mortality. However, there is a paucity of data demonstrating the impact that quality initiatives have on documentation of health-assessment metrics including risk of mortality (ROM), severity of illness (SOI), case mix index (CMI), and mortality index (MI). As a department, we evaluated the impact of a multifactorial quality initiative on mortality and quality metrics in a hospital neurological surgery service. METHODS Records of 5434 consecutive neurosurgery patients and all mortalities were prospectively collected and retrospectively reviewed from July 2014 to June 2016 at Duke University Medical Center. A multi-factorial quality improvement intervention to reduce mortality and improve documentation was implemented in July 2015, and the next 12-months were used for comparison with the previous 12-months in respect to MI, CMI, ROM, SOI present on admission (POA) and at hospital discharge (DC). For all mortality cases, we also collected Diagnosis-Related Group (DRG) codes, procedure type and etiology of mortality. RESULTS >Compared to the Pre-intervention total cohort (n = 2793), the Post-intervention total cohort (n = 2641) trended to have a decreased mean-observed monthly mortality (3.08 vs. 4.17) and mean-monthly mortality index (0.73 vs. 0.98). Additionally, the Post-intervention cohort had significantly higher CMI (3.14 vs. 2.96, P = 0.02), POA-ROM (1.52 vs. 1.46, P = 0.02), POA-SOI (1.97 vs. 1.84, P = 0.0002), DC-ROM (1.69 vs. 1.58, P = 0.003), and DC-SOI (2.1 vs. 1.95, P < 0.0001) when compared to the Pre-intervention cohort. Of 131 mortalities (Pre-intervention: n = 70, Post-intervention: n = 61), the Post-intervention mortality cohort trended to have a higher proportion of mortality cases due to emergent-(88.7% vs. 75.0%) and trauma-(43.5% vs. 36.2%) admissions than elective. CONCLUSION Our study suggests that our quality initiative impacted mortality and improving overall quality of care for elective neurological cases, while emergent/trauma cases may not have benefitted as much due to the acute severity of those cases.