Logan Reid
A significant number of people pass away in hospitals each year, with estimates ranging from 700,000 to 800,000 in the United States alone. While the percentage of hospital deaths has decreased over time, it remains a common occurrence. Various factors influence the high number of hospital deaths, including the unpredictability of death, the complexity of certain medical conditions, and the perceived ability of medical care to cure illnesses. Additionally, the culture of medicine and the availability of aggressive inpatient treatment contribute to the preference for dying in a hospital setting. Despite this, studies suggest that most people would prefer to pass away at home, and recent trends indicate a shift towards fewer in-hospital deaths and an increase in deaths at home or in hospice care.
| Characteristics | Values |
|---|---|
| Number of people dying in hospitals in the US each year | 700,000-776,000 |
| Percentage of deaths occurring in hospitals (US) | 35.1% in 2018 |
| Percentage of deaths occurring in hospitals (US) over time | Decreased from 48.0% in 2000 to 35.1% in 2018 |
| Number of deaths in hospitals in the US in 2017 | 764,424 |
| Percentage of deaths occurring in hospitals (US) in 2003 | 39.7% |
| Percentage of deaths occurring in hospitals (Canada) in 2017 | 59.9% |
| Percentage of deaths occurring in hospitals (England) in 2017 | 46.0% |
| Most common causes of death in hospitals | Sepsis, medical errors (including misdiagnosis, malpractice, and medication errors), preventable ailments, communication failures |
| Mortality rates in for-profit hospitals vs. non-profit hospitals | Higher in for-profit hospitals |
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What You'll Learn
Misdiagnosis and medical errors
Medical errors, including misdiagnosis, are a serious public health problem and a leading cause of death in the United States. While the exact numbers are difficult to pinpoint due to varying study methodologies and definitions of medical errors, it is clear that a significant number of people die or suffer permanent disability due to misdiagnosis and other medical errors.
A recent Johns Hopkins study found that more than 250,000 people in the United States die every year from medical errors, making it the third leading cause of death after heart disease and cancer. Other reports claim the numbers to be as high as 440,000. However, these figures may be inflated due to the inclusion of studies that focus on harm from medical care rather than preventable deaths, and the challenge of determining causation between medical errors and deaths.
A 2020 meta-analysis by Yale University researchers estimated approximately 22,000 preventable deaths annually, while a Colorado and Utah study extrapolated to over 33.6 million hospital admissions in the US in 1997 suggested at least 44,000 deaths due to medical errors. A New York study based on the same number of admissions put the figure at 98,000. These studies highlight the potential for preventable adverse events, with deaths exceeding those from motor vehicle accidents, breast cancer, or AIDS.
Misdiagnosis is a significant contributor to medical errors and patient harm. A study by the Johns Hopkins Armstrong Institute Center for Diagnostic Excellence found that across all clinical settings, including hospitals, an estimated 795,000 Americans die or are permanently disabled by diagnostic errors annually. The top five conditions causing the most serious harms are stroke, sepsis, pneumonia, venous thromboembolism, and lung cancer, with stroke being missed in 17.5% of cases. Other factors leading to misdiagnosis include clinician fatigue, distraction, failure to consider differential diagnoses, and inadequate patient follow-up care.
Medication errors are another critical aspect of medical errors, with an estimated 3.75 billion drug administrations to patients in hospitals. These errors can result in adverse drug reactions, therapeutic failures, and even death. Improving diagnosis and addressing systemic issues in healthcare are imperative to reduce the incidence of medical errors and their impact on patient safety.
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Patient preference for home death
Although many people do not want to die in hospitals, a significant number of deaths still occur there. This discrepancy can be attributed to various factors, including the unpredictable nature of death, the overestimation of medical care's ability to cure incurable illnesses, and a lack of alternative care options for patients who require more support than can be provided at home.
However, there is a growing movement to prioritize patient preferences in end-of-life care, and home death is preferred by most people. This preference is especially prominent among patients with life-threatening illnesses, such as end-stage cancer, and their families. Patients express a desire to retain control over their lives, maintain their autonomy, and live as meaningful a life as possible until death. To achieve this, person-centered care, continuity, and predictability in home care services are essential.
Data from the Centers for Disease Control and Prevention (CDC) reveals that the percentage of deaths occurring in hospitals in the United States decreased from 48.0% in 2000 to 35.1% in 2018. During the same period, the percentage of deaths in the decedent's home increased from 22.7% to 31.4%. This shift indicates a growing trend toward fulfilling patient preferences for home death.
Despite the preference for home death, it may not always be possible or preferable for certain individuals. Additionally, home deaths are declining in many countries. This decline could be attributed to various factors, including the availability and acceptability of alternative care sites, such as hospice settings. Furthermore, patients with certain conditions, such as dementia, have a greater likelihood of death in a nursing facility, while those with respiratory diseases have higher odds of death in a hospital.
To ensure high-quality end-of-life care, it is crucial to gather more information about the experiences of patients dying at home. By addressing the gaps and enhancing strategies to align care with patient preferences, we can positively impact the lives of those facing terminal illnesses and their families.
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Cancer patients and hospice care
Hospice care is a special type of care that focuses on a person's quality of life and dignity as they near the end of their life. It is often considered when cancer treatments are no longer effective or when a patient chooses to prioritize their comfort over curative efforts. Hospice care can be initiated when a person's cancer can no longer be controlled, and they are expected to live for less than six months.
Hospice care for cancer patients aims to improve their quality of life by easing symptoms and providing emotional support. It involves pain management, where patients are provided with medication to alleviate pain, trouble breathing, or tiredness. Hospice also offers family care, where a nurse or social worker keeps family members informed about the patient's condition and educates them about the process of dying, providing emotional support. Spiritual care is also an integral part of hospice, where doctors work with patients based on their specific spiritual and religious beliefs, discussing the meaning of death and any relevant rituals.
Hospice care can be provided in various settings, including at home, in a nursing home, hospital, or any inpatient center. It is important to note that hospice care does not treat cancer itself but focuses on managing symptoms and side effects. Palliative care, which is a type of comfort care, can be included as part of hospice care to help manage discomfort, pain, nausea, and other side effects. It addresses mental, physical, emotional, social, and spiritual issues that may arise during this difficult time.
The decision to transition to hospice care can be challenging, and it is often guided by established medical guidelines. Key indicators include the point at which cancer treatments are no longer effective in controlling tumor growth or when the patient voluntarily chooses to discontinue active treatments. Hospice care teams may include doctors, nurses, social workers, home health aides, and volunteers, all working together to ensure the patient's comfort and dignity as they approach the end of their life.
While most people prefer not to die in hospitals, about one-third of deaths in the United States occur in hospitals. However, there has been a decreasing trend in hospital deaths, with more people opting for hospice or home-based care. This shift is attributed to improved availability and acceptance of alternative care sites, as well as a growing awareness that inpatient treatment is not always the preferred option for terminal illnesses.
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For-profit hospitals and mortality rates
While most people do not want to die in hospitals, about one-third of deaths in the US occur in hospitals. In 2018, the Centers for Disease Control and Prevention (CDC) reported that the percentage of deaths from all causes that occurred in a hospital decreased from 48% in 2000 to 35.1% in 2018. During that period, the percentage of deaths that occurred at the decedent's home increased from 22.7% to 31.4%, while the percentage that occurred in long-term care facilities (hospice, nursing home, long-term care) increased from 22.9% to 26.8%.
Despite the downward trend in hospital deaths, the focus now shifts to for-profit hospitals and their impact on mortality rates. For-profit hospitals have been a subject of debate, especially with studies indicating higher mortality rates compared to non-profit hospitals. A systematic review and meta-analysis of studies comparing mortality rates between private for-profit and private not-for-profit hospitals in the United States revealed concerning findings. The study, led by Dr. PJ Devereaux from McMaster University, reviewed 15 observational studies encompassing 26,000 hospitals and 38 million patients. The results showed that patients treated at for-profit hospitals had a 2% increased risk of death. This translates to approximately 14,000 deaths each year in the United States.
The higher mortality rates in for-profit hospitals are attributed to several factors. Firstly, shareholders in these hospitals expect a substantial return on their investments, often ranging from 10% to 15%. To meet these financial expectations, hospitals may cut corners on skills and staff training, compromising the quality of care. Additionally, funding constraints from fixed sources, such as Medicare and other insurance schemes, can further pressure hospitals to reduce costs, potentially impacting patient outcomes. The pressure to generate revenues and satisfy investors, coupled with higher administrative costs and large executive bonuses, can directly affect patient care and safety.
The implications of higher mortality rates in for-profit hospitals extend beyond the United States. In Canada, for instance, the debate surrounds the potential entry of private, for-profit hospitals into the country's national health insurance plan. Opponents of this idea, including Dr. Devereaux, argue that allowing for-profit hospitals into Canada could lead to increased mortality. He estimates that it would result in about 2,200 extra deaths per year in Canada, a significant number comparable to deaths from suicide, colon cancer, or traffic crashes.
The concerns about for-profit hospitals are not limited to mortality rates alone. A pair of studies from the Canadian Medical Association Journal revealed that for-profit hospitals also had significantly higher costs. On average, they had 19 percent higher costs than non-profit hospitals, further emphasizing the financial pressures and potential impact on patient care and outcomes. These findings have sparked discussions about the role of for-profit hospitals in publicly financed healthcare systems and the potential consequences for patients and communities.
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Sepsis: a leading cause of death
Sepsis is a life-threatening condition that occurs when the body's immune system has an extreme response to an infection, causing organ dysfunction and failure, and sometimes death. It is a significant cause of maternal, neonatal, and child mortality, contributing to global efforts to improve quality care and reduce mortality rates in these vulnerable populations.
According to the World Health Organization (WHO), sepsis is responsible for one in five deaths worldwide, or 20% of all global deaths. This translates to approximately 11 million sepsis-related deaths each year, with many of them being children. The incidence of sepsis has been declining, with a 19% drop in cases and a 30% decrease in deaths between 1990 and 2017. However, the impact of sepsis is more significant in low- and middle-income countries, with serious gaps in knowledge and limited data availability.
Sepsis can be caused by bacterial, viral, parasitic, or fungal infections. It is commonly associated with healthcare-acquired infections, particularly in intensive care units, and antimicrobial resistance poses a significant challenge in its treatment. Early diagnosis and timely, appropriate clinical management, including optimal antimicrobial use and fluid resuscitation, are crucial for increasing the likelihood of survival.
The prevention and management of sepsis are linked to various factors, such as vaccine coverage, universal health coverage, improved sanitation, and water quality. Additionally, individual practices like handwashing, vaccinations, and proper antibiotic use can reduce the risk of developing sepsis. Despite these preventive measures, sepsis remains a leading cause of death, outpacing previously recognized leading causes such as cancer and coronary disease.
The high mortality rate associated with sepsis underscores the urgent need for a coordinated global response to tackle this crisis. Efforts to improve data collection and understanding of sepsis, especially in low- and middle-income countries, are imperative to detect and treat this condition effectively worldwide.
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Frequently asked questions
Over 700,000 people die in hospitals in the US annually.
Yes, the number of people dying in hospitals has decreased over time. In 2003, 905,874 deaths occurred in hospitals, and this number dropped to 764,424 in 2017. In 2018, the number further decreased to 715,000.
The percentage of deaths occurring in hospitals has decreased from 48.0% in 2000 to 35.1% in 2018. In 2017, the percentage was 29.8%.
Many deaths in hospitals are due to medical errors, sepsis, and other preventable ailments. Medical errors include misdiagnosis, communication failures, and technical complications.
