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Recently, Provenzano and colleagues found that an electronic tool
collecting real-time clinical information directly from front-line
providers was both feasible and useful to evaluate inpatient deaths .
These findings concur with our evaluation of the preventability of death
using a simple electronic evaluation tool in our 46-bed adult Intensive
From September 2010 to Sept...
From September 2010 to September 2011 an email was send to the
attending intensivist each time a patient died in our intensive care
including 2 questions: "Was this death preventable? If yes, what was the
cause of preventability?". The definition of preventable mortality was
provided using three criteria: the illness was survivable, care was
suboptimal, and suboptimal care was related to death. No reminding emails
were sent. In addition, the patient charts of all cases were
retrospectively reviewed by two ICU nurses and a physician.
A total of 306 patients (9.9%) died. APACHE IV Standardised Mortality
Rate was 0.77. In 48 of these deceased patients the APACHE IV based
mortality risk was below 20%. Response rate was 92% and 47 deaths (15%)
were reported to be potentially preventable. Large inter-individual
variations between the intensivists (n=24) were observed. Response varied
between 65% and 100% and preventable death judgments varied from none to
66%. When using blinded chart review was by the nurses and physician
judged death potentially preventable in 7%, 11%, and 18%, respectively.
Alike Provenzano et al. we also found poor agreement between the
preventability ratings from front-line intensivist reviews when compared
to blinded chart review . In 21 cases (45%) in which the intensivist
scored a preventable death all three reviewers scored these non-
preventable. This might partly be explained by additional information on
each patient's individual circumstances that cannot easily be deduced from
patients' charts. Using APACHE IV as selection criterion for in-depth
evaluation is insufficient while analysis of patients with an APACHE IV
based risk of mortality below 20% showed that only 4 of these deaths
(8.3%) were considered potentially preventable .
Preventability of death evaluation of all inpatient deaths is
required either for quality improvement and/or by regulatory authorities.
A quick and efficient method with high response rates from front-line
providers is feasible and may provide useful information for quality
improvement . However, large inter-individual variations in response
and judgment exist and, therefore, this method apparently is insufficient
1. Provenzano A, Rohan S, Trevejo E, et al. Evaluating inpatient
mortality: a new electronic review process that gathers information from
front-line providers. BMJ Qual Saf 2015;24:31-37.
2. Hayward RA, Hofer TP. Estimating hospital deaths due to medical errors:
preventability is in the eye of the reviewer. JAMA 2001;286:415-20.
3. Girling AJ, Hofer TP, Wu J, et al. Case-mix adjusted hospital mortality
is a poor proxy for preventable mortality: a moddeling study. BMJ Qual Saf
4. Dijkema LM, Dieperink W, van Meurs M, et al. Preventable mortality
evaluation in the ICU. Crit Care 2012;16:309.