Avoidable deaths?  No such thing.   Death can only be postponed.

Will hospital mortality league tables  be a good thing?  Well the link between poor care and premature death seems to be weak.

My local hospital (Wythenshawe) did a case note review of all 1440 deaths in the hospital between July 2013 and July 2014. They concluded that there was a potentially preventable mortality  (grades 4-6 as per the BMJ paper) of 1.1%.  The clinicians (and I) thought this exercise was well worth doing, though there were substantial costs.

But 1420 of the people who died in the hospital had deaths which were pretty clearly not preventable.  The mean length of stay of those who died was 15.6 days.  So on the face of it more than  20,000 bed days were occupied by people who probably derived little benefit from being in hospital.  The review didn’t investigate at what stage it became clear that they were going to die, and I suppose that varies quite a lot.  But there seems general agreement that many people arrive at hospitals in a condition where death is the obvious outcome.  And not many people think that a busy acute medical ward, or a casualty department is a good place to die.

In 2013 about half the people who died in England and Wales died in hospital. If Wythenshawe is at all typical they took up about 7 million bed days.  If we could reduce that figure by even 10% then we might not have a crisis in casualty departments across the country.

Place of death

Place of death2013
Total506,790
Home113,071
Care homes107,090
Hospices27,102
Hospitals248,238
Elsewhere11,289
Deaths registered in England and Wales

 

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2 Comments

  1. 10 February 2015
    Dear Mr Rathfelder
    I am interested to read your article and would like to ask questions to the specific survey undertaken.
    1] How many of these patients were on a “death” pathway of any description?
    2] How many of these patients were categorised as “terminal” patients before they died?
    3] How many of these patients had case reviews where alternative treatment might have given them longer time to live, be it hours, days, weeks, months of years?
    I think there is a fine line between consciously making all concerted efforts to save a patient regardless of cost, and accepting that death is inevitable. We are all mortals. But it is in the spirit of human beings to strive to preserve life at all costs.

  2. Martin Rathfelder says:

    I don’t know the answer to any of these questions. The main figures are from death registrations. The investigation at Wythenshawe did not study those issues. They were investigating whether the deaths could have been prevented, and found that hardly any of them were.

    It’s interesting to discover that doctors chose to die with less medical intervention than other people.

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