title: Cluster deaths in long-term care institutions: an investigation of excess deaths in two Ontario institutions.
abstract: OBJECTIVE
  To review clusters of deaths in two Ontario long-term care institutions and to establish whether common etiologic factors could be identified.
  
  
  METHODS
  Retrospective review of the health care records of all residents who died to assess the events leading to death and the actions of the institutions and local coroners in response to the deaths.
  
  
  RESULTS
  A respiratory infectious outbreak appeared to lead to many of the deaths in both institutions. Several deficiencies were identified with respect to charting practices, coroners' case investigations and institutional responses to the infectious outbreaks. No formal mechanisms were in place to assist in the early detection of cluster deaths in these institutions.
  
  
  CONCLUSIONS
  Infectious outbreaks may be an important cause of cluster deaths in long-term care institutions. Standards should be developed for patient charting, coroners' investigations and for the prevention, identification and management of infectious outbreaks in such settings.
authors.affiliation: Division of General Internal Medicine, Toronto Hospital, Ontario.
authors.forename: G
authors.initials: G
authors.lastname: Naglie
authors.forename: B
authors.initials: B
authors.lastname: Goldlist
authors.forename: J
authors.initials: J
authors.lastname: Kirkland
authors.forename: M
authors.initials: M
authors.lastname: Gordon
authors.forename: K
authors.initials: K
authors.lastname: Klapecki
authors.forename: J
authors.initials: J
authors.lastname: Young
authors.forename: P
authors.initials: P
authors.lastname: Clark
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016000:Cluster Analysis; D003428:Cross Infection / Q000401:mortality* / Q000517:prevention & control; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D009864:Ontario / Q000453:epidemiology; D012141:Respiratory Tract Infections / Q000401:mortality* / Q000517:prevention & control; D012189:Retrospective Studies; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data*