• The observed mortality is the number of patient deaths that occur in the hospital for any reason.
  
  
• The expected mortality is the predicted number of deaths in the hospital based on the hospital's patients' levels of illness. Patients who are very sick (higher severity of illness) have a higher expected mortality rate. The expected mortality rate does not reflect a hospital's quality of care. If two hospitals had patients with exactly the same severity of illnesses, the hospitals' expected mortality rates would be the same.
  
  Many children admitted to Lucile Packard Children's Hospital are very sick. They have complicated medical conditions that increase the chances that they will die (their expected mortality) – their survival is less likely than for less sick children. Example: A baby born three months premature is sicker and has a more complicated medical condition than a patient with a broken leg. So, the premature baby has a higher expected mortality. 
  
  
• The standard ratio of 1.0 indicates that the observed mortality rate equaled the expected mortality rate based on patients’ level illness.  A mortality ratio under 1.0 means that more patients survived than were expected due to the severity of their illnesses.

Mortality Ratio January 2007-December 2007

Mortality Ratio Trended Over Time

What We Are Doing to Improve the Mortality Ratio

• Implementing Rapid Response Teams. Physicians, nurses and respiratory therapists work 24x7 to proactively evaluate patients whose symptoms indicate a possible life-threatening event. The teams determine if immediate medical intervention is needed to prevent the life-threatening event. This quick response to a patient’s changing condition has led to a(n):
  • 80 percent decrease in cardiorespiratory arrests outside of the intensive care unit (ICU) setting
  • 17 percent decrease in mortality across the entire hospital. Lucile Packard Children’s Hospital earned the Child Health Corporation of America's (CHCA) 2007 RACE for Results award for its success in implementing Rapid Response Teams.
    
    
• Implementing Computerized Provider Order Entry (CPOE). CPOE is a computerized system that allows direct entry of medical orders by a licensed health care provider. Entering orders directly into a computer:
  • Reduces errors due to poor handwriting
  • Ensures accurate drug ordering
  • Identifies drug allergies
  • Improves quality and efficiency of health care delivery
    
    
• Reducing surgical site infection rates. We follow the best practices recommended by the Institute for Healthcare Improvement (IHI) and the Centers for Disease Control and Prevention (PDF). We are part of a national collaboration of approximately 20 children’s hospitals that follows these practices.
  
  
• Reducing catheter associated bloodstream infections (CABSI). We have implemented the recommendations from the IHI Prevention of Central Line-Associated Bloodstream Infection campaign (PDF). You can also learn more about our CABSI infection rates.