Antecedents to hospital deaths

Authors

  • K. M. Hillman,

    1. 1 University of New South Wales, 2Department of Intensive Care, Liverpool Hospital, 3Epidemiology Unit, South Western Sydney Area Health Service, 4Department of Intensive Care, St George Hospital, Sydney and 5Department of Intensive Care, Illawarra Regional Hospital, Wollongong, New South Wales, Australia
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  • 1 P. J. Bristow,

    1. 1 University of New South Wales, 2Department of Intensive Care, Liverpool Hospital, 3Epidemiology Unit, South Western Sydney Area Health Service, 4Department of Intensive Care, St George Hospital, Sydney and 5Department of Intensive Care, Illawarra Regional Hospital, Wollongong, New South Wales, Australia
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  • 2 T. Chey,

    1. 1 University of New South Wales, 2Department of Intensive Care, Liverpool Hospital, 3Epidemiology Unit, South Western Sydney Area Health Service, 4Department of Intensive Care, St George Hospital, Sydney and 5Department of Intensive Care, Illawarra Regional Hospital, Wollongong, New South Wales, Australia
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  • 3 K. Daffurn,

    1. 1 University of New South Wales, 2Department of Intensive Care, Liverpool Hospital, 3Epidemiology Unit, South Western Sydney Area Health Service, 4Department of Intensive Care, St George Hospital, Sydney and 5Department of Intensive Care, Illawarra Regional Hospital, Wollongong, New South Wales, Australia
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  • 2 T. Jacques,

    1. 1 University of New South Wales, 2Department of Intensive Care, Liverpool Hospital, 3Epidemiology Unit, South Western Sydney Area Health Service, 4Department of Intensive Care, St George Hospital, Sydney and 5Department of Intensive Care, Illawarra Regional Hospital, Wollongong, New South Wales, Australia
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  • 4 S. L. Norman,

    1. 1 University of New South Wales, 2Department of Intensive Care, Liverpool Hospital, 3Epidemiology Unit, South Western Sydney Area Health Service, 4Department of Intensive Care, St George Hospital, Sydney and 5Department of Intensive Care, Illawarra Regional Hospital, Wollongong, New South Wales, Australia
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  • 2 G. F. Bishop,

    1. 1 University of New South Wales, 2Department of Intensive Care, Liverpool Hospital, 3Epidemiology Unit, South Western Sydney Area Health Service, 4Department of Intensive Care, St George Hospital, Sydney and 5Department of Intensive Care, Illawarra Regional Hospital, Wollongong, New South Wales, Australia
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  • and 2 G. Simmons 5

    1. 1 University of New South Wales, 2Department of Intensive Care, Liverpool Hospital, 3Epidemiology Unit, South Western Sydney Area Health Service, 4Department of Intensive Care, St George Hospital, Sydney and 5Department of Intensive Care, Illawarra Regional Hospital, Wollongong, New South Wales, Australia
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Ken Hillman, Professor of Intensive Care, University of New South Wales, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW 1871, Australia. Email: k.hillman@unsw.edu.au

Abstract

Background: Recent studies have suggested there are a large number of potentially preventable deaths in Australian hospitals.

Aim: This study aimed to document antecedent factors in hospital deaths in an attempt to identify potentially preventative factors.

Methods: The study was conducted at three separate acute hospitals. Demographics of all deaths were recorded over a 6-month period as well as antecedent factors present within 0–8 and 8–48 h of all deaths including vital sign abnormalities, cardiorespiratory arrests and admission to intensive care. Separate analysis was performed on ‘not for resuscitation’ deaths.

Results: There were a total of 778 deaths, of which 549 (71%) were ‘not for resuscitation’. There were 171 (22%) deaths preceded by arrest and 160 (21%) preceded by admission to intensive care. Of the remaining deaths, 30% had severely abnormal physiological abnormalities documented. This incidence was 50% in the non-do not resuscitate (DNR) subgroup. Concern about the patient’s condition was expressed in the patient’s notes by attending nursing staff and junior medical staff in approximately one-third of non-DNR deaths. Hypotension (30%) and tachypnoea (17%) were the most common antecedents in the non-DNR deaths.

Conclusion: There is a high incidence of serious vital sign abnormalities in the period before potentially preventable hospital deaths. These antecedents may identify patients who would benefit from earlier intervention. (Intern Med J 2001; 31: 343–348)

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