Ideal Mortality Rate in a General Ward
There is no established "ideal" mortality rate for general wards, but mortality rates of 1.5-6.7% are considered acceptable based on current evidence, with rates varying based on patient population characteristics and hospital systems. 1
Understanding General Ward Mortality
General ward mortality rates vary significantly based on several factors:
- Patient acuity and case mix significantly impact mortality rates, with higher rates seen in wards with more complex patients 2
- Mortality rates of 6.7% overall have been reported in multicenter studies of patients discharged from ICU to general wards 1
- Only approximately 3.1% of hospital deaths are considered preventable, with even fewer (0.5-1.0%) among patients with life expectancy greater than 3 months 3
Factors Influencing General Ward Mortality
Patient-Related Factors
- Age and comorbidities significantly affect mortality risk 4
- Frailty status is a strong predictor of mortality, with all deaths in some studies occurring in patients classified as frail 4
- Severity of illness at admission correlates with mortality risk 1
System-Related Factors
- Implementation of Rapid Response Teams (RRTs) or Medical Emergency Teams (METs) can reduce general ward mortality (Class IIa, LOE C-LD) 4
- Daily physician ward rounds are associated with 10% lower odds of mortality compared to less frequent rounds 5
- Higher ratios of nurses trained in specialized skills (e.g., swallow screening in stroke patients) correlate with reduced mortality 5
Mortality Prediction Tools
Several scoring systems help predict mortality risk in general wards:
The Sabadell score at ICU discharge effectively stratifies patients into four mortality risk groups:
- Score 0 (good prognosis): 1.5% ward mortality
- Score 1 (long-term poor prognosis): 9% ward mortality
- Score 2 (short-term poor prognosis): 23% ward mortality
- Score 3 (expected hospital death): 64% ward mortality 1
For specific populations like elderly trauma patients, specialized tools like the Geriatric Trauma Outcome Score (GTOS) can predict mortality with reasonable accuracy 4
Quality Improvement Strategies to Optimize Mortality Rates
Early Warning Systems
- Early Warning Sign Systems (EWSS) may be considered for adults and children (Class IIb, LOE C-LD) to identify deteriorating patients before critical events 4
- Pediatric Early Warning Systems (PEWS) may be considered in facilities caring for high-risk children 4
Rapid Response Systems
- Implementation of RRTs/METs is associated with significant improvements in hospital survival and decreased incidence of in-hospital cardiac arrests 4
- Continuous assessment of at-risk patients is essential until stabilization 4
- Delays in transfer to ICU are associated with increased mortality (1.5% increase in hospital mortality for each hour of delay) 4
End-of-Life Care Considerations
- Appropriate Do Not Attempt Resuscitation (DNAR) orders and palliative care for patients with terminal conditions are important components of mortality management 4
- Effective communication, expert care, respectful and compassionate care, and trust in clinicians are the most important elements of end-of-life care identified by patients and families 6
Common Pitfalls in Managing General Ward Mortality
- Failure to recognize early signs of deterioration in patients 4
- Delays in initiating appropriate interventions for deteriorating patients 4
- Inadequate staffing levels, particularly of specialized nursing staff 5
- Lack of regular physician assessment (daily rounds) 5
- Inappropriate escalation of care or failure to institute timely DNAR orders 4
Conclusion
While there is no single "ideal" mortality rate for general wards, rates between 1.5-6.7% are commonly reported in well-functioning systems. The focus should be on implementing evidence-based practices like rapid response teams, early warning systems, appropriate staffing, and daily physician rounds to optimize outcomes rather than targeting a specific mortality percentage.