Epidemiology of in-hospital mortality in acute patients admitted to a tertiary level hospital.
Intern Med J. 2016 Feb 3;
Authors: Le Guen M, Tobin A
BACKGROUND: Health care professionals may have difficulty in recognizing the dying patient in acute care settings and yet this is essential if timely end of life care is to be provided. Whilst approximately a third of patients who die in-hospital are reviewed by the rapid response team (RRT), there is limited available research on other factors associated with death within the hospital setting.
AIMS: To describe the epidemiology of in-hospital mortality within a tertiary level hospital, particularly in the context of RRT activation.
METHODS: Database extraction of demographic, admission and RRT activation data on acute patients discharged from an Australian acute tertiary hospital between 1 January 2009 and 31 December 2013. Analyses included simple descriptors, Chi-squared and non-parametric Kruskal Wallis tests as appropriate.
RESULTS: Of 44 297 patients discharged from our hospital, 1603 died during admission. The general medical, haematology/oncology and intensive care teams provided care for the majority of the patients who died. A small number of diagnoses had in-patient mortality rates of greater than 25%. These included respiratory failure, alcoholic liver disease, vascular disorders of the intestine, sepsis and aspiration pneumonia. Over 75% of patients who received a RRT call survived to hospital discharge, however patients who received 4 or more RRT calls during admission had an in-hospital mortality rate of over 40%.
CONCLUSION: Acute in-patient mortality is unequally distributed throughout the hospital and a small number of diagnoses have large associated in-patient death rates. Repeated involvement of the RRT is associated with in-patient mortality.
PMID: 26841313 [PubMed - as supplied by publisher]