Background The proportion of avoidable hospital deaths is challenging to estimate, but has great implications for quality improvement and health policy. Many studies and monitoring tools are based on selected high-risk populations, which may overestimate the proportion. Mandatory reporting systems, however, under-report. We hypothesise that a review of an unselected sample of hospital deaths will provide an estimate of avoidability in-between the estimates from these methods.
Methods A retrospective case record review of an unselected population of 1000 consecutive non-psychiatric hospital deaths in a Norwegian hospital trust was conducted. Reviewers evaluated to what degree each death could have been avoided, and identified problems in care.
Results We found 42 (4.2%) of deaths to be at least probably avoidable (more than 50% chance of avoidability). Life expectancy was shortened by at least 1 year among 34 of the 42 patients with an avoidable death. Patients whose death was found to be avoidable were less functionally dependent compared with patients in the non-avoidable death group. The surgical department had the greatest proportion of such deaths. Very few of the avoidable deaths were reported to the hospital’s report system.
Conclusions Avoidable hospital deaths occur less frequently than estimated by the national monitoring tool, but much more frequently than reported through mandatory reporting systems. Regular reviews of an unselected sample of hospital deaths are likely to provide a better estimate of the proportion of avoidable deaths than the current methods.
- mortality (standardised mortality ratios)
- medical error, measurement/epidemiology
- healthcare quality improvement
- health policy
- chart review methodologies
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Contributors All authors are responsible for the presented results and have participated in the design and concept, analysis and interpretation of data, or drafting and revising of the manuscript. Specifically, all authors have approved the final version.
Funding This study was funded by the St Olav’s University Hospital, Norwegian University of Science and Technology and the Norwegian Medical Association’s fund for quality and patient safety.
Disclaimer The funding source was not involved in the design of the study, statistical analyses or interpretation of the results. The researchers were independent from the funding source.
Competing interests None declared.
Patient consent Not required.
Ethics approval Regional Committees for Medical and Health Research Ethics, REC Central.
Provenance and peer review Not commissioned; externally peer reviewed.
Correction notice This article has been corrected since it published Online First. The funding information has been corrected as well as the author affiliations.