Surveying Care Teams after in-Hospital Deaths to Identify Preventable Harm and Opportunities to Improve Advance Care Planning

Published:November 22, 2017DOI:https://doi.org/10.1016/j.jcjq.2017.06.013

      Background

      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.

      Methods

      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.

      Results

      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.

      Conclusion

      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 die.
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      Biography

      David Lucier, MD, MBA, MPH, CPPS, formerly Fellow of Patient Safety and Quality, Harvard Medical School, Boston, is Director of Quality Improvement and Patient Safety, Hospital Medicine, Massachusetts General Hospital, Boston.

      Biography

      Patricia Folcarelli, RN, MA, PhD, is Vice President, and Cheryle Totte, RN, MS, is Director of Patient Safety, Silverman Institute for Health Care Quality and Safety, Beth Israel Deaconess Medical Center, Boston.

      Biography

      Alexander R. Carbo, MD, is Director of Quality Improvement, Department of Medicine, Beth Israel Deaconess Medical Center, Boston.

      Biography

      Lauge Sokol-Hessner, MD, is Site Director, Harvard Medical School Fellowship in Patient Safety and Quality, Boston, and Associate Director of Inpatient Quality, Department of Health Care Quality, Beth Israel Deaconess Medical Center.