Reviewing in-hospital deaths is one way of learning how to improve the quality and
safety of care. Postdeath surveys sent to the care team for patients who died may
have a role in identifying opportunities for improvement. As part of a quality improvement
initiative, a postdeath care team survey was developed to explore how it might augment
the existing process for learning from deaths.
A survey was sent to the care team for all inpatient deaths on the hospital medicine
and medical ICU services at one institution. Survey responses were reviewed to identify
cases that required further investigation. An iterative process of inductive coding
was used to create a coding taxonomy to classify survey response free-text comments.
During the distribution period (September 25, 2015–December 28, 2015), 82 patients
died, and 191 care team members were surveyed. Responses (138; 72.3% response rate)
were collected through January 28, 2016. Based on the survey responses, 5 patients
(6.1%) not identified by other review processes were investigated further, resulting
in the identification of several important opportunities for improvement. The free-text
comment analysis revealed themes around the importance of advance care planning in
seriously ill patients, as well as evidence of the emotional and psychological strain
on clinicians who care for patients who die.
Postdeath care team surveys can augment mortality review processes to improve the
way hospitals learn from deaths. Free-text comments on such surveys provide information
not otherwise identified during traditional mortality review processes, including
the importance of advance care planning and the strain on clinicians whose patients