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Around 12,000 preventable acute hospital deaths per year

Around 12,000 deaths in acute hospitals in England each year could be prevented, according to a data analysis published recently online in BMJ Quality and Safety.1 The findings are based on the case record reviews of 1,000 adult patient deaths at 10 randomly selected acute hospitals across England in 2009.

Researchers looked for potential acts of omission or commission contributing to a death, taking account of the patients’ overall health at the time. 
They used a scale, ranging from one (definitely not preventable) to six (definitely preventable). They also estimated the life expectancy on admission to gauge which groups of patients were most affected.

131 patients were judged to have experienced a problem in the care they received, which contributed to their death. They were almost twice as likely to be admitted under surgical specialties.
5.2% of all deaths had a ≥50% chance of not having happened, but for certain aspects of the care the patients had received while in hospital.

Treatment of salineProblems occurred at all stages of care, but 37 problems (44%) contributing to preventable death had occurred during ward care.
Preventable deaths were associated with poor clinical monitoring in almost one in three cases (31%); the wrong diagnosis in just under 30% of cases; and poor drug or fluid management in one in five cases (21%).

If the 5% proportion of preventable deaths were extrapolated across all acute hospital admissions in England, the overall tally would be just under 12,000 (11,859) – a figure that is considerably less than previous estimates have suggested, though still substantial, say the authors.
Over half of all these deaths (60%) were in frail, elderly patients with multiple health problems who were not expected to live for more than a year.

“While the spectre of preventable hospital deaths may prove helpful in raising interest in patient safety and a commitment to improvement, overestimating the size of the problem and the risk to patients may induce unjustified levels of anxiety and fear among the public,” say the authors.

“In addition, confirmation of the relatively small proportion of deaths that appear to be preventable provides further evidence that overall hospital mortality rates are a poor indicator of quality of care.”

References

1. Hogan H, Healey F, Neale G, Thomson R, Vincent C, Black N. Preventable deaths due to problems in care in English acute hospitals: a retrospective case record review study. BMJ Qual Saf 2012.  doi:10.1136/bmjqs-2012-001159

Published on: July 24, 2012

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