Patient safety is up, so is patient acuity

Editor's Note

Patient safety indicators measured by case mix index and risk-adjusted in-hospital mortality show a return to pre-pandemic improvement trajectories in US hospitals, according to research findings published November 12 in JAMA.

These findings come from a retrospective cohort study that looked at encounter-level administrative and financial data from 1,300+ hospitals in the US from the Vizient Clinical Data Base. Specifically, investigators examined inpatient discharges between October 2019 and March 2024 to see if US hospitals had resumed pre-pandemic improvement trajectories in risk-adjusted mortality and case mix index following the disruptions caused by the COVID-19 pandemic. Indeed, they found that risk-adjusted in-hospital mortality declined significantly from Q3-2021 through Q1-2024, while patient acuity as measured by case mix index remained elevated compared with pre-pandemic levels, despite a post-2020 decline. These findings suggest that patient acuity has increased to a new post-pandemic baseline, while risk-adjusted mortality has resumed its pre-pandemic trajectory of improvement, per the study. 

The investigators suggested that follow-up research should further clarify post-pandemic patient safety trends such as hospital type and region to better characterize variability. This could further clarify how the COVID-19 pandemic continues to influence hospital case mix and clinical outcomes.