Counterintuitive: Inpatient Mortality is Not a Good Metric To Judge Hospital Performance

A new study shows how the measure is biased against safety-net institutions.

Today I’m going to tell you a story of good intentions, and intentions gone awry.

The setting? Hospitals across the United States. The antagonist? Sepsis.

Sepsis is the leading cause of death among hospitalized patients — responsible for around 300,000 deaths per year in the US. And with sepsis, time is of the essence. The quicker we can diagnose a patient, the quicker we can initiate treatment, and the more likely they are to survive. Our window to save a life in the setting of severe sepsis is measured in hours, not days.

Recognizing the importance of rapid diagnosis and treatment, multiple states — most notably New York — have instituted mandatory sepsis guidelines and public reporting of outcomes. The Center for Medicare Services has recognized this as well — implementing sepsis care as one of their key quality measures. CMS reports data on hospital compliance with sepsis guidelines as well as outcomes. Here’s the data from my hospital, for example.