Mortality rates are one important patient safety and care quality indicator. Wide variations in hospital mortality rates for homogeneous patient populations persist even after effective risk and case mix adjustment procedures are completed to account for the effects of patient characteristics on mortality. This suggests that some hospitals have structures and processes that better prevent unnecessary death.

The purpose of this study was to test the Determinants of Mortality Model to determine which hospital characteristics affect 30-day mortality rates for general medicine and surgery patients. Differences were found in the determinants of mortality for medical and surgical patients. Nursing staff mix, continuity of care provider, proportion of baccalaureate-prepared nurses, use of care maps guiding patient care, and adequacy of resources were found to be determinants of mortality for acute medical patients but not for surgical patients.

Hospital nurse executives who have patient safety and quality target goals related to preventing unnecessary patient death should engage in deliberate decision making about nurse staff mix, continuity of care providers, and use of care maps, particularly for their acute medical patients. Findings can be used to identify the amount of unnecessary death that is avoidable for hospitalized medical patients by adjusting the determinants of mortality.