Antecedents to hospital deaths

Background: Recent studies have suggested there are a large number of poten tially preventable deaths in Australian hospitals. Aim: 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. Demogra phics of all deaths were recorded over a 6-month period as well as antecede nt 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% ha d severely abnormal physiological abnormalities documented. This incidence was 50% in the non-do not resuscitate (DNR) subgroup. Concern about the pat ient'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 i n the non-DNR deaths. Conclusion: There is a high incidence of serious vital sign abnormalities i n the period before potentially preventable hospital deaths. These antecede nts may identify patients who would benefit from earlier intervention.