Reducing the reported mortality index within a neurocritical care unit through documentation and coding accuracy

Abstract Background/Objective The mortality index, or the ratio of observed to expected mortality, is a reported quality metric that is assumed to directly reflect patient care. However, documentation and coding that does not utilize knowledge of how a reported mortality index is derived may reflect poorly on a hospital or service line. We present our effort at reducing the reported mortality index of neurosurgery and neurology patients within a neurocritical care unit through documentation and coding accuracy with direct incorporation of mortality modeling. Methods Utilizing published methodology from Vizient Inc. we generated a spreadsheet tool enabling direct manipulation of data to identify documentation and coding issues that influenced the reported mortality index in a retrospective set of patients. Subsequently we implemented prospective changes to documentation and coding comparing our calculated mortality index to the reported Vizient Inc. mortality index. Results Prospective implementation of documentation and coding issues identified through our spreadsheet tool resulted in a drastic reduction of both our calculated and the reported Vizient Inc. mortality index. Conclusions Incorporating knowledge of mortality index modeling into documentation and coding resulted in impressive reductions in the reported mortality index for our patients, serving as a both an internal benchmark and a means of comparison to other institutions.