Berechnung der Hospital Standardized Mortality Ratio (HSMR) für deutsche Krankenhäuser im Zeitverlauf von 2005 bis 2012

Objective: Assess for continued improvements in patient outcomes after updating our institutional sedation and analgesia protocol to include recommendations from the 2013 Society of Critical Care Medicine (SCCM) Pain, Agitation, and Delirium (PAD) guidelines. Methods: Retrospective before-and-after study in a mixed medical/surgical intensive care unit (ICU) at an academic medical center. Mechanically ventilated adults admitted from September 1, 2011 through August 31, 2012 (pre-implementation) and October 1, 2012 through September 30, 2017 (post-implementation) were included. Measurements included number of mechanically ventilated patients, APACHE IV scores, age, type of patient (medical or surgical), admission diagnosis, ICU length of stay (LOS), hospital LOS, ventilator days, number of self-extubations, ICU mortality, ICU standardized mortality ratio, hospital mortality, hospital standardized mortality ratio, medication data including as needed (PRN) analgesic and sedative use, and analgesic and sedative infusions, and institutional savings. Results: Ventilator days (Pre-PAD = 4.0 vs. Year 5 post = 3.2, P < .0001), ICU LOS (Pre-PAD = 4.8 days vs. Year 5 post = 4.1 days, P = .0004) and hospital LOS (Pre-PAD = 14 days vs. Year 5 post = 12 days, P < .0001) decreased after protocol implementation. Hospital standardized mortality ratio (Pre-PAD = 0.69 vs. Year 5 post = 0.66) remained constant; while, APACHE IV scores (Pre-PAD = 77 vs. Year 5 post = 89, P < .0001) and number of intubated patients (Pre-PAD = 1146 vs. Year 5 post = 1468) increased over the study period. Using the decreased ICU and hospital LOS estimates, it is projected the institution saved $4.3 million over the 5 years since implementation. Conclusions: Implementation of an updated PAD protocol in a mixed medical/surgical ICU was associated with a significant decrease in ventilator time, ICU LOS, and hospital LOS without a change in the standardized mortality ratio over a five-year period. These favorable outcomes are associated with a significant cost savings for the institution.

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Estimation of the cumulated exposure to polychlorinated dibenzo-p-dioxins/furans and standardized mortality ratio analysis of cancer mortality by dose in an occupationally exposed cohort.

Environmental Health Perspectives ◽

10.1289/ehp.98106655 ◽

1998 ◽

Vol 106 (suppl 2) ◽

pp. 655-662 ◽

Cited By ~ 48

Author(s):

D Flesch-Janys ◽

K Steindorf ◽

P Gurn ◽

H Becher

Keyword(s):

Cancer Mortality ◽

Standardized Mortality Ratio ◽

Ratio Analysis ◽

Occupationally Exposed ◽

Mortality Ratio

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The APACHE II measured on patients' discharge from the Intensive Care Unit in the prediction of mortality

Revista Latino-Americana de Enfermagem ◽

10.1590/s0104-11692013000300022 ◽

2013 ◽

Vol 21 (3) ◽

pp. 811-819 ◽

Cited By ~ 3

Author(s):

Luciana Gonzaga dos Santos Cardoso ◽

Paulo Antonio Chiavone

Keyword(s):

Linear Regression Analysis ◽

Prognostic Index ◽

Apache Ii ◽

Standardized Mortality Ratio ◽

Good Discrimination ◽

Risk Of Death ◽

Prediction Of Mortality ◽

Significant Area ◽

Mortality Ratio ◽

Good Calibration

OBJECTIVE: to analyze the performance of the Acute Physiology and Chronic Health Evaluation (APACHE II), measured based on the data from the last 24 hours of hospitalization in ICU, for patients transferred to the wards. METHOD: an observational, prospective and quantitative study using the data from 355 patients admitted to the ICU between January and July 2010, who were transferred to the wards. RESULTS: the discriminatory power of the AII-OUT prognostic index showed a statistically significant area beneath the ROC curve. The mortality observed in the sample was slightly greater than that predicted by the AII-OUT, with a Standardized Mortality Ratio of 1.12. In the calibration curve the linear regression analysis showed the R2 value to be statistically significant. CONCLUSION: the AII-OUT could predict mortality after discharge from ICU, with the observed mortality being slightly greater than that predicted, which shows good discrimination and good calibration. This system was shown to be useful for stratifying the patients at greater risk of death after discharge from ICU. This fact deserves special attention from health professionals, particularly nurses, in managing human and technological resources for this group of patients.

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Can Standardized Mortality Ratio Be Used To Compare Quality of Intensive Care Unit Performance?

Critical Care Medicine ◽

10.1097/00003246-199410000-00038 ◽

1994 ◽

Vol 22 (10) ◽

pp. 1708-1709

Author(s):

Jack E. Zimmerman ◽

William A. Knaus ◽

Douglas P. Wagner

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Standardized Mortality Ratio ◽

Mortality Ratio ◽

Unit Performance

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Estimation of standardized mortality ratio with missing death certificates

Mathematical and Computer Modelling ◽

10.1016/j.mcm.2004.02.029 ◽

2004 ◽

Vol 40 (5-6) ◽

pp. 491-498 ◽

Cited By ~ 2

Author(s):

R.C. Gupta ◽

Bingxia Wang

Keyword(s):

Standardized Mortality Ratio ◽

Death Certificates ◽

Mortality Ratio

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All-Cause Mortality of Hospital-Treated Borderline Personality Disorder: A Nationwide Cohort Study

Journal of Personality Disorders ◽

10.1521/pedi_2018_32_403 ◽

2020 ◽

Vol 34 (6) ◽

pp. 723-735 ◽

Cited By ~ 8

Author(s):

Jesper N⊘rgaard Kjær ◽

Robert Biskin ◽

Claus Vestergaard ◽

Povl Munk-J⊘rgensen

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

Mortality Rate ◽

Borderline Personality ◽

High Rate ◽

Standardized Mortality Ratio ◽

Central Research ◽

Emergency Rooms ◽

Icd 10 ◽

Mortality Ratio

Patients with borderline personality disorder (BPD) are known to present frequently in emergency rooms, and they have a high rate of suicide. The mortality rate of patients with BPD is still unclear. The Danish Psychiatric Central Research Register and The Danish Register for Causes of Death were used to identify patients with a first-ever diagnosis of BPD (ICD-10: F60.31) from 1995 through 2011 together with time and cause of death. A total of 10,545 patients with a BPD diagnosis were followed for a mean time of 7.98 years. A total of 547 deaths were registered. The standardized mortality ratio of patients with BPD compared to the general population was 8.3 (95% CI [7.6, 9.1]). More than three inpatient admissions per year or a comorbid diagnosis of substance use disorder correlated with a higher mortality rate. The increased mortality rate in patients with BPD treated in secondary care emphasizes that it is a severe mental disorder.

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