Preventable in-hospital deaths and years of life lost were uncommon among patients in a Finnish secondary teaching hospital

Abstract

<p><strong>Background: </strong>Despite quality standards and trained personnel, deaths caused by adverse events occur in healthcare. Estimates of in-hospital deaths caused by avoidable harm are contradictory. Old age and comorbidities increase the risk of death from adverse events. The aim of this retrospective study was to analyze the rate of preventable deaths associated with adverse events and their relationship with life expectancy among hospitalized patients with somatic disease.</p><p><strong>Methods: </strong>The study examined all deaths in a Finnish secondary teaching hospital over one year, in 2017. The medical records of adult patients in somatic wards whose in-hospital deaths were unanticipated upon admission were analyzed. Two separate, independent reviewers evaluated the association of death with existing adverse events and estimated the preventability of death on a 5-point scale. The years of life lost were estimated among patients whose death was considered potentially or likely preventable.</p><p><strong>Results: </strong>The total number of unanticipated deaths among adult in-hospital somatic patients during the study year was 253. Altogether 236 patients died in the hospital, and 17 end-of-life patients at discharge died within 30 days. The median age at death was 79.9 years, and the median number of chronic conditions was three. Among the deaths evaluated as the means of two reviewers, 95.3% were estimated to be not preventable, and 4.7% were estimated to be potentially or likely preventable. The latter patients were younger and had fewer comorbidities. Half of them were considered to have a competing cause that would have led to death in the coming months. Among those whose deaths were considered likely preventable, only one patient would have likely lived for more than three months.</p><p><strong>Conclusion: </strong>The assessment of avoidable inpatient mortality is challenging but important for improving the safety of healthcare. According to this study, preventable deaths caused by adverse events and years of life lost were uncommon. Large-scale studies with adequate analysis of clinical data are needed to update the estimates and causes of deaths related to adverse events.</p>