Survival Improvement Tactics

We seek to understand and improve mortality both in and out of the hospital setting. To that end, we partner with clinical teams across Duke Health to utilize case reviews, data analytics, and project management in the following areas:

DUHS Mortality Review. We systematically review mortalities to identify opportunities to improve our systems of care. Resources:

• • • • • Reviewing Deaths to Save Lives: A Standardized Approach to Mortality Review. May 2017
        • DUHS Mortality Review Poster, IHI National Forum. December 2017

Survival Improvement Initiatives. We have led ongoing initiatives to improve clinical outcomes, specifically to: reduce in-hospital delirium, prevent aspiration, identify and manage sepsis and clinical deterioration, and facilitate care transitions between settings. More recently, we have focused on improving end-of-life care delivery. Our initiatives include:

Enhancing inpatient advance care planning. Using a machine-learning model, we identify patients at high-risk for mortality, engage them in discussions about end-of-life care, and document their preferences, which are accessible by the whole care team. Resources:

• • • • • Targeted Advance Care Planning and Multi-Disciplinary Care Using Machine Learning, Vizient Connections Education Summit. September 2020
        • Utilizing a Machine Learning Mortality Model to Implement Targeted Advance Care Planning and Multi-Disciplinary Care Review. May, 2021
        • ACP Clinical Impact in Solid Tumor Oncology Patients. 2022
        • ACP Provider Education
        • Goal-Concordant Care: End-of-Life Planning Conversations for All Seriously Ill Patients: NEJM Catalyst. November, 2022
        • The Use of Templates for Documenting Advance Care Planning Conversations: A Descriptive Analysis. Journal of Pain and Symptom Management. August, 2023
        • Implementation of a Hospital Medicine  Department Level Physician Incentive for Promoting Documentation of Advanced Care Planning Conversations, Duke Health Quality and Safety Conference, April 2024
        • QI-study-using-a-machine-learning-mortality-risk-prediction-model-notification-system-on-ACP-in-high-risk-patients_Journal of Br
        • Machine Learning for Targeted ACP in Cancer Patients_Journal of Pain and Symptom Management_2024

Optimizing patient pathways to hospice and end-of-life care. Hospice care helps patients and their caregivers manage terminal illness more effectively and face the end of life with dignity and comfort. We seek to identify patients who would benefit from hospice care and ease the transition to that care. Resources:

• • • • • ED to Hospice Project Work, Objectives/Tools. June 2021
        • Increasing Access to Hospice Through the Creation of an Emergency Department to Hospice Workflow. 2022
        • Increasing Access to General Inpatient (GIP) Hospice Services at Duke University Hospital. 2022
        • Hospice Pathways Folder (Duke NetID Required)

Contacts
Yvonne Acker, RN, BSN, CPHQ, Program Manager, DUHS Survival Improvement. Contact: yvonne.acker@duke.edu
Dr. Pooh Setji, Medical Director, DUHS Mortality Review, DUH Hospital Medicine. Contact: noppon.setji@duke.edu