title: [Mortality analysis as a tool for quality improvement in a general surgery service].
abstract: OBJECTIVE
  The present study aims to propose a method to improve healthcare quality based on systematic analysis of mortality and mortality-related adverse effects.
  
  
  METHODS
  We analyzed all deaths in the surgery service between January, 1997 and December, 2003. There were 10,905 hospital admissions and 194 deaths. The mean number of deaths per year was 28 (range 24-36). The mean number of deaths/discharges per year was 1.77 (SD 0.2; range 1.5-2.13). The overall mean age was 80.5 years (SD 9.5; range 47-100). By sex there were 104 women (53.6%) and 90 men (46.6%). During the study period 9,437 patients underwent surgery. We defined the concept of death secondary to a hospital problem (DSHP): this easily objectified concept includes any hospital problem occurring from admission to death associated directly or indirectly with death, or simply precipitating a foreseeable death.
  
  
  RESULTS
  We detected 33 DSHP. Of all deaths, 17% were DSHP. In these DSHP, 37 problems were detected (some deaths involved more than one problem). The most frequent types of problem were three nosocomial infections, 19 problems secondary to therapeutic or diagnostic techniques, seven insufficient evaluations or treatment omissions or delays, and eight harmful incidents. No deaths occurred because of organizational or structural problems. The number of DSHP in relation to discharges was 0.3%.
  
  
  CONCLUSIONS
  We present a system of continuous self-evaluation, in which problems are recognized and a constructive attitude is adopted. The model can be extrapolated to other hospitals but the results must be evaluated in the specific context of each hospital. Nevertheless, the results can be used for monitoring within a single center over a period of years.
authors.affiliation: Cirugía General, Hospital General de Vic, Barcelona, España. 26709arm@comb.es
authors.forename: Andreu
authors.initials: A
authors.lastname: Romaguera Monzonís
authors.forename: Angels
authors.initials: A
authors.lastname: Moleiro
authors.forename: Xavier
authors.initials: X
authors.lastname: de Castro
authors.forename: Nuria
authors.initials: N
authors.lastname: Belloso
authors.forename: Mouna
authors.initials: M
authors.lastname: Taouragt
authors.forename: Enrique
authors.initials: E
authors.lastname: de Caralt
authors.forename: Raquel
authors.initials: R
authors.lastname: Carrera
authors.forename: Constatí
authors.initials: C
authors.lastname: Serra
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D006769:Hospitals, General; D006801:Humans; D008297:Male; D008875:Middle Aged; D011785:Quality Assurance, Health Care / Q000592:standards*; D013030:Spain; D013503:Surgery Department, Hospital / Q000592:standards* / Q000706:statistics & numerical data*