A Structured Deterioration Response Program across a Multihospital System to Reduce Inpatient Mortality

Unrecognized physiologic deterioration is a persistent challenge across health care systems, resulting in missed opportunities for early intervention and reduced inpatient mortality. Early detection and structured response protocols may improve clinical outcomes. In this retrospective propensity-matched cohort study, the authors evaluate the effectiveness of the Discover, Evaluate, Triage, Evaluate, and Respond (DETER) program on clinical outcomes among adult inpatients across a large, multihospital health system. Of 99,558 eligible admissions, 39,703 intervention cases were matched 1:1 to control cases. In-hospital mortality was 1.7% in the intervention group and 2.9% in the control group, representing a 41% relative reduction. The average hospital length of stay was 6.7 days in the intervention group and 7.1 days in the control group. The rates of hospice discharge, intensive care unit transfers, and upgrades to higher levels of care were decreased in the intervention group. Rapid response team activations increased from 6.7% in the control group to 10.2% in the intervention group (P<0.001), reflecting earlier clinical recognition and intervention. These findings suggest that the DETER program may represent a scalable model for improving patient safety and overall hospital performance.