Mortality Reduction Strategies

At Emplify Health, inpatient mortality metrics were higher than those of their peers, which did not align with their perception of patient care. Previous efforts to address this metric were ineffective, as no single intervention could drive significant improvement. In 2021, Gundersen Health System (now Emplify Health) prioritized inpatient mortality as a key quality metric. Utilizing Vizient’s mortality data methodology, they adopted a new approach to tackle this issue through interdisciplinary collaboration and strategic data usage to implement a portfolio of projects aimed to promote communication and enhance patient care throughout the organization.

The initiative began with data analysis and interdisciplinary case study reviews to understand patient experiences, systemic barriers, and clinical care provided. This process highlighted the need to improve goals of care conversations and expand end-of-life care options. They tracked metrics over time and networked with other organizations to learn about their systems and workflows. A half-day interdisciplinary workshop was held to assess the impact and feasibility of various potential projects. The selected initiatives included:

1. Enhanced End-of-Life Care Options
   - Developed a process for inpatient hospice admissions if eligible.
   - Implemented tele-palliative consultations with surrounding Critical Access Hospitals.

2. Clinician-Level Triage in the Admission/Referral Hub
   - Explored coding and documentation opportunities to ensure data accuracy.

The newly developed process allowing eligible inpatient patients to be admitted to hospice has not only facilitated more discharges home to hospice but has also enhanced communication between the Inpatient Palliative Medicine and Hospice teams. Additionally, the implementation of a Clinician in our admission/referral hub and tele-palliative consults has continued to assist in triaging potential transfer patients, ensuring that incoming transfers provide value to the patient and that appropriate goals of care discussions have occurred. Furthermore, our Clinical Documentation Inpatient staff have implemented Vizient’s Interactive Risk Model Calculator to ensure accurate coding reflecting patient acuity levels, thereby impacting our observed/expected rate. Moving forward, our next steps involve implementing condition-specific mortality review sessions and standardizing goals of care conversations with patients by utilizing standard triggers and easily accessible documentation for all members of the care team.

The overall inpatient mortality metric improved, decreasing from an observed/expected rate of 1.46 in FY 2022 to 1.09 in FY 2023 (0.96 in FY 2024 to date). Continuing efforts in 2024 focus on standardizing goals of care conversations, enhancing advance care planning, maintaining the mortality review process, and utilizing end-of-life predictive analytics to identify patients who could benefit from goals of care discussions.