RWJBarnabas Initiatives Reduce Hospital Mortality Rate by 20%

Two EHR tools, a deterioration index and a sepsis alert, have helped to drive hospital mortality rate reductions.

Several initiatives at RWJBarnabas Health over the past two years have led to a significant reduction in the hospital mortality rate.

Coming out of the coronavirus pandemic, leadership at the West Orange, N.J.-based health system realized there was room to improve the mortality rate at their 12 acute care hospitals, says Andy Anderson, MD, MBA, executive vice president and chief medical and quality officer.

"We recognized a couple of years ago the opportunity to improve our mortality outcomes after doing an analysis of those outcomes across the health system's hospitals," he says. "We saw that we could improve."

RWJBarnabas put together a team to create "tactics" that could move the needle on mortality, and they encouraged hospital CMOs and CNOs to focus on ways to improve mortality, Anderson says.

Andy Anderson, MD, MBA, is executive vice president and chief medical and quality officer at RWJBarnabas Health. Photo courtesy of RWJBarnabas Health.

EHR alerts are drivers of change

The health system is using two tools in the Epic EHR to facilitate those improvements.

An AI-based tool called the deterioration index looks broadly at a patient’s healthcare data, including vital signs, history, physical exam, and laboratory results.

"The deterioration index predicts whether a patient is more or less likely to die," Anderson says. "There is a red, yellow, and green alert system. If the alert is red there is a high likelihood that the patient is going to die. When the deterioration index indicates that a patient is at risk of dying, we send a rapid response team to intervene at the bedside."

The rapid response team is typically staffed by a physician or advanced practice provider as well as a nurse, Anderson says.

"They go to the bedside, examine the patient, and make a determination on the spot about whether the patient needs to go to the ICU," he says. "The rapid response team contacts the patient's hospital care team and gives their assessment as quickly as possible.”

"We have seen powerful results," he adds. "The deterioration index saves lives."

The other tool is a sepsis alert. The EHR tool scans patient data and can pick up on the likely presence of sepsis, the body's life-threatening reaction to an infection that has been linked to about a third of hospital deaths nationwide.

Once the EHR flags a patient with a sepsis alert, hospital care teams move quickly to intervene, Anderson says.

"We have worked to have a standardized order set for patients who are septic," he says. "We are making sure they are getting the right antibiotic, making sure they get an antibiotic quickly, making sure they get fluids, and making sure there is appropriate monitoring of these patients. We also make sure the source of the sepsis is identified, whether it is pneumonia or another source."

Anderson says the health system has also created a team to develop best practice for sepsis management.

Mortality review process and ICU care

RWJBarnabas has also launched a mortality review process, which basically means reviewing and learning from a patient's death.

"Each of our hospitals has a team that reviews those cases and identifies whether there are any learning opportunities," Anderson says. "They go back and educate the team that took care of a deceased patient when learning opportunities arise."

The health system can then take those lessons from its 12 hospitals, put them in a single database, and identify common themes, Anderson says.

"For example, we may identify themes in cardiology or neurology cases, then we can go back to the service line and discuss how they can perform better or think differently in the future," he says. "Sometimes, there is nothing to learn from a death, but other times there is something to learn, and we must share that knowledge."

Another mortality reduction initiative has focused on ICU care, Anderson says.

"We are making sure that patients who are on ventilators are getting the right care," he says. "We are making sure that we have appropriate staffing in our ICUs. We are making sure we have enough ICU beds."

Generating results

RWJBarnabas is heading in the right direction by focusing on the right things, Anderson says.

"We have reduced mortality by 20% across our health system hospitals over the past two years," he says.

The mortality reduction initiatives reflect how RWJBarnabas approaches patient safety and quality in three ways, Anderson says.

"No. 1, we are using data to drive improvement," he says. "We know more clearly how we are doing and the goals we need to achieve. We are monitoring mortality data over time. No. 2, we are working as a health system, sharing best practices, and identifying the best ways to do this work. No. 3, we are using our electronic health record as a driver of change. Examples of using the EHR to address mortality include the deterioration index and the sepsis alert. Epic is helping us standardize best practices."

RWJBarnabas is sharing information about its mortality reduction efforts through dashboards and a monthly meeting called the High-Reliability Organization Cabinet, which includes leadership from all 12 hospitals.

"We are looking at the outcomes regularly," Anderson says. "We are looking at the tactics regularly. We are making sure that progress is being made regularly."