Antecedents to hospital deaths.
BACKGROUND
Recent studies have suggested there are a large number of potentially preventable deaths in Australian hospitals.


OBJECTIVE
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.


CONCLUSIONS
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.
Hillman
K M
KM
University of New South Wales, Liverpool Hospital,  Australia. k.hillman@unsw.edu.au
Bristow
P J
PJ
Chey
T
T
Daffurn
K
K
Jacques
T
T
Norman
S L
SL
Bishop
G F
GF
Simmons
G
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000517:prevention & control*; D006339:Heart Rate; D017052:Hospital Mortality; D006801:Humans; D007022:Hypotension / Q000150:complications / Q000175:diagnosis; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012119:Respiration; D012131:Respiratory Insufficiency / Q000150:complications / Q000175:diagnosis; D016414:Resuscitation Orders; D012307:Risk Factors; D013997:Time Factors