Using in-Hospital Mortality as an Indicator of Quality Care and Hospital Performance

Abstract

In-hospital mortality (MIH) is used as a performance indicator and quality healthcare in hospitals. However, the majority of deaths resulted from an inevitable disease process (severity of cases and/or co-morbidity), and not medical errors or changes in the quality of care. This work aims to make a distribution of deaths in the Regional Hospital of Eastern, Al Farabi hospital and to highlight that more studies on the MIH are required consistently with detailed clinical data at admission. The MIH showed its limitation as a health care indicator. The overall rate of in-hospital deaths within the Al Farabi hospital has averaged 2.4%, with 8.4% in the emergency unit, 28% in the intensive care unit, 22% Neonatology unit, 1.6% in the pediatric unit. The MIH may depend, firstly, on the condition of patients before hospitalization and secondly, on the conditions of their transfer from one institution to another that supports them as a last resort. Al Farabi hospital supports patients transferred from the provinces of the eastern region. Thus, 6% of patients who died in 2014 come from Berkane, 2% from  Nador, 2% from Bouarfa, 4% from  Taourirt, and 2% from Jerrada. One might question the procedures and the conditions of such transfers. In conclusion, the overall MIH measured from routine data does not allow proper comparison between hospitals or the assessment of the quality of care and patient safety in the hospital. To do so, we should ideally have detailed clinical data on admission (e.g. type of admission, age of patient, sex, comorbidity, ...). The MIH is however an important indicator to consider as a tool to detect potential problems related to admission procedures and to suspect an area of "non-quality" in healthcare. The MIH is interesting for the patient and for the hospital because it serves the improvement of quality healthcare.