Earlier this month I published a story in Forbes on the importance of reducing in-hospital death rates.
Even among the “best” hospitals in Manhattan, the chances of leaving by the morgue instead of the front door are twice as high in some hospitals as compared to others. One explanation often bandied about concerns the patient population, with some hospitals claiming that their patients are more at risk of death before they even make it to the hospital because of the complexity of their conditions. But this “get me off the hook” excuse does not explain why some hospital systems have reduced in-hospital death rates by 50% over the past few years while others have not. Those that have improved all made concerted multiyear efforts to reduce their death rate and improve other outcomes across the board.
COVID-19 adds new urgency to the issue as critically ill patients are flooding our hospitals. I was struck by one number in particular in a recent report on COVID-19 patient outcomes. In the largest hospital system in New York, Northwell Health, 88% of COVID-19 patients placed on ventilators died. For those over 65, the number was even higher at 97%. These numbers are comparable to those reported from some Chinese hospitals.
Shocked by these numbers I asked the CEOs of two hospital systems with better than average in-hospital death rates for their outcomes. At NYU Langone the current death rate for ventilated COVID-19 patients is 48%. For those at Rush in Chicago the death rate is slightly under 40%, even though Rush is a referral hospital for the most difficult COVID-19 cases in the city.
I am not surprised that the hospitals that have made a significant effort in developing systems to improve patient outcomes and reduce in-hospital deaths also do better with critically ill COVID-19 patients. It is time for all our hospitals to learn from the best, so that all patients, no matter where they are treated and no matter what their disease, are given the best chance medicine can offer.