Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012 Sep;21(9):737-45.
doi: 10.1136/bmjqs-2011-001159.

Preventable deaths due to problems in care in English acute hospitals: a retrospective case record review study

Helen Hogan  1 , Frances Healey, Graham Neale, Richard Thomson, Charles Vincent, Nick Black
Affiliations

Preventable deaths due to problems in care in English acute hospitals: a retrospective case record review study

Helen Hogan et al. BMJ Qual Saf. 2012 Sep.

Erratum in

  • BMJ Qual Saf. 2013 Feb;22(2):182

Abstract

Introduction: Monitoring hospital mortality rates is widely recommended. However, the number of preventable deaths remains uncertain with estimates in England ranging from 840 to 40 000 per year, these being derived from studies that identified adverse events but not whether events contributed to death or shortened life expectancy of those affected.

Methods: Retrospective case record reviews of 1000 adults who died in 2009 in 10 acute hospitals in England were undertaken. Trained physician reviewers estimated life expectancy on admission, to identified problems in care contributing to death and judged if deaths were preventable taking into account patients' overall condition at that time.

Results: Reviewers judged 5.2% (95% CI 3.8% to 6.6%) of deaths as having a 50% or greater chance of being preventable. The principal problems associated with preventable deaths were poor clinical monitoring (31.3%; 95% CI 23.9 to 39.7), diagnostic errors (29.7%; 95% CI 22.5% to 38.1%), and inadequate drug or fluid management (21.1%; 95% CI 14.9 to 29.0). Extrapolating from these figures suggests there would have been 11 859 (95% CI 8712 to 14 983) adult preventable deaths in hospitals in England. Most preventable deaths (60%) occurred in elderly, frail patients with multiple comorbidities judged to have had less than 1 year of life left to live.

Conclusions: The incidence of preventable hospital deaths is much lower than previous estimates. The burden of harm from preventable problems in care is still substantial. A focus on deaths may not be the most efficient approach to identify opportunities for improvement given the low proportion of deaths due to problems with healthcare.

PubMed Disclaimer

Conflict of interest statement

Competing interests: All authors have completed the unified competing interest form at http://www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that neither authors nor their family relations have a financial or non-financial interest that might be relevant to the submitted work.

Comment in

References

    1. Institute of Medicine To Err Is Human: Building A Safer Health Care System. Washington DC: Institute of Medicine and National Academy Press, 1999
    1. Department of Health An Organisation with a Memory: Report of an Expert Group on Learning from Adverse Events in the NHS. Chaired by the Chief Medical Officer. London: Department of Health, 2000
    1. Leape LL, Brennan TA, Laird N, et al. The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med 1991;324:377–84 - PubMed
    1. Thomas EJ, Studdert DM, Burstin HR, et al. Incidence and types of adverse events and negligent care in Utah and Colorado. Med Care 2000;38:261–71 - PubMed
    1. Wilson R, Runciman W, Gibberd R, et al. Quality in Australian Health Care Study. Med J Aust 1995;163:472–5 - PubMed

Publication types

MeSH terms