The study, published in BMJ Quality and Safety, found the majority of poor care associated with preventable deaths was the result of poor monitoring of the patient’s condition, wrong diagnosis or errors in medication or fluid replacement.
Something went wrong (described as an adverse event) in about 13% of adult patients who died in acute hospitals in England. However, the researchers concluded that their subsequent death was due to the adverse event, and therefore preventable, in less than half of these patients (5.2% of all deaths) – equivalent to 11,859 adult preventable deaths in hospitals in England.
Current Department of Health and the National Audit Office estimates suggest there are 40,000 preventable deaths each year in England.
The new findings, funded by the National Institute for Health Research, are based on the most detailed study of hospital deaths ever conducted in England. Researchers from the London School of Hygiene & Tropical Medicine with colleagues at Imperial College London, Newcastle University and the National Patient Safety Agency studied 1,000 randomly selected patients who died in 10 hospitals during 2009. Their medical records were intensively reviewed by highly experienced doctors who looked not only for any clinical errors committed but also for any failures to investigate or treat patients correctly.
Doctors reviewing the medical records also assessed each patient’s likely survival on admission to hospital. This showed that most preventable deaths occurred in those who were severely ill with multiple conditions and would have had less than a year to live.
The authors concluded: “The incidence of preventable hospital deaths is much lower than previous estimates based on studies that did not assess the causal relationship between problems in care identified and subsequent death. The burden of harm from preventable problems in care is still substantial. A focus on deaths may not be the most efficient approach to detecting healthcare-related harm and identifying opportunities for improvement given the low proportion of deaths due to problems with healthcare.”
“Although the quality of care that three-quarters of patients received was judged to be good or excellent, there is clearly plenty of scope for improvement in clinical practice,” they added. “The principal area of concern is clinical monitoring on the ward.”
The lead researcher, Dr Helen Hogan of the London School of Hygiene & Tropical Medicine, said: “While any patient dying from an adverse event is a tragedy and any deaths in hospital due to poor care are of considerable concern, it is important that our estimate of the size and impact of the problem is accurate and we understand what we can do to prevent such incidents. Hospitals can and must learn from careful analysis of individual preventable deaths and make every effort to avoid any preventable deaths.
“Currently, there is considerable emphasis on hospitals reviewing their mortality rates. However, if 95% of deaths in hospital are not due to preventable poor care, not only is the scope for hospitals to demonstrate reduction in their mortality rate limited, but also the overall mortality rate is not a meaningful indicator of the quality of a hospital.”
For more information and to request interviews with Dr Hogan, please contact the LSHTM press office on 020 7927 2802 or email email@example.com.
Notes to Editors:
1. Preventable deaths due to problems in care in English acute hospitals: a retrospective case record review study. Helen Hogan, Frances Healey, Graham Neale, Richard Thomson, Charles Vincent, Nick Black. BMJ Quality & Safety doi:10.1136/bmjqs-2012-001159
2. The funders of the study, the National Institute for Health Research, Research for Patient Benefit Programme had no role in study design, data collection, data analysis, data interpretation, or composition of the report.
3. Reviewers judged 5.2% of 1,000 deaths as having a 50% of greater chance of being preventable. Extrapolating from these figures suggest there would have been 11,859 adult preventable deaths in hospital in England.
4. Examples of deaths judged to be preventable:-
- A female patient in her early 80s presented with watery diarrhoea. Diagnosis of inflammatory bowel disease took 18 days despite a past history of the disease. The patient had deteriorated significantly before appropriate treatment started and she failed to respond.
- Male patient in his 60s with previous history of ischaemic heart disease and carcinoma of the bladder underwent an unnecessary procedure due to misdiagnosis as recurrent cancer. The actual diagnosis was congestive heart failure and he suffered a myocardial infarction after the procedure and went into multi-organ failure.
- Middle aged male patient developed infection at the site of a surgical procedure. Antibiotic treatment was continued despite a failure to improve and subsequent open drainage proved too late.
5. Image: IV drip. Credit: iStockphoto.com/CarlssonInc