Where do people die?

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