Tessa Quinn
The American Hospital Association reports that there are 6,093 hospitals in the United States. While the number of deaths in hospitals has decreased over the years, a significant number of people still die in hospitals. In 2018, about one-third of deaths in the country occurred in hospitals, with over 700,000 people dying in hospitals each year. This decrease in hospital deaths can be attributed to various factors, including improved treatment options and the availability of alternative care sites. However, medical errors are a significant concern, with a Johns Hopkins study estimating that over 250,000 people in the US die annually from such errors, making it the third-leading cause of death.
| Characteristics | Values |
|---|---|
| Number of inpatient hospital deaths in 2000 | 776,000 |
| Number of inpatient hospital deaths in 2010 | 715,000 |
| Percentage decrease in inpatient hospital deaths from 2000 to 2010 | 8% |
| Average length of stay for patients who died in the hospital in 2010 | 7.9 days |
| Average length of stay for all inpatients in 2010 | 4.8 days |
| Percentage of inpatient hospital deaths among patients aged 65 and over in 2000 and 2005 | 75% |
| Percentage of inpatient hospital deaths among patients aged 65 and over in 2010 | 73% |
| Percentage of inpatient hospital deaths among patients aged 85 and over in 2000 and 2005 | 25% |
| Percentage of inpatient hospital deaths among patients aged 85 and over in 2010 | 27% |
| Percentage of hospital deaths from all causes that occurred in a hospital in 2000 | 48.0% |
| Percentage of hospital deaths from all causes that occurred in a hospital in 2018 | 35.1% |
| Number of deaths in US emergency rooms between 1997 and 2011 | Almost halved |
| Rate of deaths in US emergency rooms per 1,000 adults | Decreased from 1.48 to 0.77 |
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What You'll Learn
Medical errors are the third-leading cause of death in the US
There are 6,093 hospitals in the United States, and the number of inpatient hospital deaths decreased by 8% from 776,000 in 2000 to 715,000 in 2010. The percentage of deaths from all causes that occurred in a hospital decreased from 48.0% in 2000 to 35.1% in 2018. During that period, the percentage of deaths that occurred in the decedent's home increased from 22.7% to 31.4%, and the percentage that occurred in a long-term care facility (hospice, nursing home, long-term care) increased from 22.9% to 26.8%.
In 2000, 2005, and 2010, about 75% of the inpatients who died in the hospital were aged 65 and over. The average age of patients who died during their hospital stay was 72–73 years throughout the period from 2000 to 2010. While the overall hospital death rates declined from 2000 to 2010, the death rate due to septicemia increased by 17%. The number of inpatients who died in the hospital with a first-listed diagnosis of septicemia tripled from 45,000 in 2000 to 132,000 in 2010.
According to a Johns Hopkins study, medical errors are the third-leading cause of death in the US. Analyzing medical death rate data over an eight-year period, Johns Hopkins patient safety experts have calculated that more than 250,000 deaths per year are due to medical errors in the US. This figure surpasses the US Centers for Disease Control and Prevention's third-leading cause of death—respiratory disease, which kills close to 150,000 people per year. The researchers caution that most medical errors are not due to inherently bad doctors, and that reporting these errors shouldn't be addressed by punishment or legal action. Rather, they say, most errors represent systemic problems, including poorly coordinated care, fragmented insurance networks, the absence or underuse of safety nets, and other protocols.
The researchers are advocating for updated criteria for classifying deaths on death certificates. They argue that the CDC's way of collecting national health statistics fails to classify medical errors separately on the death certificate. According to the researchers, the CDC's criteria for collecting national health statistics do not recognize that diagnostic errors, medical mistakes, and the absence of safety nets could result in someone's death. Therefore, medical errors are unintentionally excluded from national health statistics.
The 2016 Johns Hopkins study has received criticism for its flawed methods, which involved extrapolating death rates from unrepresentative patient populations and making unsubstantiated causal connections between errors and deaths. Critics worry that exaggerating the harms of medical errors can discourage people from seeking medical care and offer an excuse for downplaying other serious risks. However, the study highlights the need for more research on preventing medical errors and addressing systemic issues in the healthcare system.
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Most Americans prefer to die at home
The number of inpatient hospital deaths in the US decreased by 8%, from 776,000 in 2000 to 715,000 in 2010, while the number of total hospitalizations increased by 11%. During the same period, the percentage of deaths from all causes that occurred in a hospital decreased from 48.0% in 2000 to 35.1% in 2018. This shift in preference for place of death is also reflected in the increase in the percentage of deaths occurring in the decedent's home, which rose from 22.7% in 2000 to 31.4% in 2018, making it the most common site of death for Americans by 2017. This shift may be influenced by cultural and social perceptions, with obituaries often describing a "good death" as one that occurred "peacefully at home, surrounded by family."
However, it is important to recognize that a home death is neither the preferred nor feasible option for everyone. While hospice care can increase the likelihood of dying at home, it is not always accessible or affordable for all Americans. Additionally, unprepared family caregivers may struggle with managing distressing symptoms, administering medications, and providing intimate personal care for their loved ones, tasks typically performed by trained clinicians in other care settings.
Despite the challenges, most people express a preference for dying at home, and the expansion of hospice care and palliative interventions has empowered many to experience a "good death" in their homes. The perception of a good death at home is deeply ingrained in American culture and history, and it is essential to respect individual choices and ensure access to quality end-of-life care, regardless of the setting.
Americans also prioritize honesty from healthcare providers about their prognosis, with 88% valuing honesty even if there is little chance of recovery. This transparency empowers individuals to make informed decisions about their end-of-life care, reflecting a desire for control over their medical choices. While hospice care is increasingly preferred, it is not a one-size-fits-all solution, and some individuals may opt for hospital-based palliative care to manage their symptoms effectively.
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Hospital death rates declined from 2000 to 2010
The percentage of deaths occurring in hospitals in the United States has decreased over the years. From 2000 to 2018, the percentage of deaths from all causes that occurred in a hospital decreased from 48.0% to 35.1%. This decline in hospital death rates was also observed between 2000 and 2010, with a notable 8% decrease in the number of inpatient hospital deaths during this period.
In the year 2000, there were 776,000 inpatient hospital deaths, which dropped to 715,000 in 2010. Interestingly, the number of total hospitalizations during this period increased by 11%. This indicates that despite an increase in hospitalizations, the number of deaths occurring in hospitals decreased.
When examining specific diagnoses, the hospital death rates for patients hospitalized for respiratory failure decreased by 35%, pneumonitis due to solids and liquids by 22%kidney disease by 65% These decreases contributed to the overall decline in hospital death rates from 2000 to 2010.
However, it is important to note that the septicemia hospital death rate increased by 17% during the same period. The number of inpatients who died in the hospital with septicemia as the first-listed diagnosis tripled from 45,000 in 2000 to 132,000 in 2010. This increase in septicemia-related deaths stands out in contrast to the overall decline in hospital death rates.
In terms of patient demographics, the average age of patients who died during their hospital stay remained relatively consistent from 2000 to 2010, ranging between 72 and 73 years. While the proportion of inpatient hospital deaths for those aged 65 and over decreased by 3%, there was a 9% increase in the percentage of hospital deaths for those under 65 years of age.
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Patients who died in hospital had longer stays
In the United States, the number of inpatient hospital deaths decreased by 8% from 2000 to 2010, dropping from 776,000 to 715,000. During this period, the total number of hospitalizations increased by 11%. The percentage of deaths occurring in hospitals decreased from 48% in 2000 to 35.1% in 2018.
Patients who died in the hospital had longer stays than those who survived. In 2010, patients who died stayed an average of 7.9 days, compared to an average of 4.8 days for all inpatients. While 45% of those who died stayed between 1-3 days, over a quarter of these patients stayed for 10 days or more. In contrast, only 57% of all inpatients had stays of 1-3 days, and only 10% stayed for 10 days or more.
The decrease in inpatient hospital deaths from 2000 to 2010 was observed across various age groups. In 2000, 2005, and 2010, about 75% of inpatients who died were aged 65 and above. The percentage of hospital deaths for those under 65 increased by 9% from 24% in 2000 to 27% in 2010. The average age of patients who died during their hospital stay was 72-73 years throughout this period.
The decline in hospital death rates from 2000 to 2010 was influenced by decreases in deaths from specific diagnoses. Hospital death rates decreased for patients hospitalized for respiratory failure (35%), pneumonitis (22%), kidney disease (65%), cancer (46%), stroke (27%), pneumonia (33%), and heart disease (16%). However, the septicemia hospital death rate increased by 17% during this period. The number of inpatients who died with septicemia as the first-listed diagnosis tripled from 45,000 in 2000 to 132,000 in 2010.
Prolonged hospitalizations, defined as stays of 21 days or longer, account for 14% of all hospital days in US hospitals. Predicting patients at risk for prolonged stays can enable early proactive management to reduce their length of stay. Risk factors for prolonged hospitalizations include having four or more chronic diseases and chronic comorbidities such as electrolyte disturbance, weight loss, coagulation disorders, and paralysis.
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Aggressive and intensive medical care can save lives, but may result in a poor quality of life
While aggressive and intensive medical care can be life-saving, it may also result in a poor quality of life for patients. This is a complex issue influenced by various factors, including patient preferences, the nature of their illness, and the potential for treatment futility.
In the United States, a significant number of people die in hospitals each year, with figures previously exceeding 700,000 annually. However, there has been a decreasing trend in hospital deaths, with an 8% drop between 2000 and 2010, even as hospital admissions increased. This suggests that advancements in treatment and the availability of alternative care options are contributing to the decline in hospital deaths.
Aggressive and intensive medical care often involve invasive procedures and interventions. While these approaches can be life-saving in many situations, they may also prolong suffering and result in a poor quality of life for patients, especially when the underlying condition is terminal or incurable. For example, a patient with advanced lung disease and a spinal injury may be kept alive through intensive procedures, but their overall well-being and quality of life may be severely compromised.
The culture of medicine and the availability of specialized care also play a role in this dynamic. Medical professionals are trained to diagnose and treat illnesses, and the presence of more specialists and hospitals in a region can lead to more aggressive treatment offerings. However, until recently, medical trainees received limited education on recognizing when treatment is futile or how to de-escalate treatment appropriately. This can result in overtreatment and unnecessary interventions that may not align with a patient's wishes or improve their quality of life.
Additionally, patient preferences and their understanding of treatment options are crucial. In the case of terminal illnesses, patients and their doctors are increasingly recognizing that inpatient treatment may not always be the best option. Discussions about end-of-life care are becoming more common, allowing individuals to express their wishes regarding the types of treatment they are willing to undergo and their preferred care settings.
While aggressive and intensive medical care can extend lives, it is essential to consider the potential impact on patients' quality of life. The focus should be on providing care that aligns with patients' values and goals, ensuring that their well-being and dignity are prioritized alongside survival.
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Frequently asked questions
More than 700,000 people die in hospitals in the US each year.
No, the number has decreased over time. Inpatient hospital deaths dropped by 8% from 2000 to 2010, from 776,000 to 715,000.
About one-third of deaths in the US occur in hospitals. The percentage of deaths in hospitals decreased from 48% in 2000 to 35.1% in 2018.
There are several reasons for the high number of deaths in American hospitals:
- Death is unpredictable, and many inpatient deaths occur after long admissions that begin with treatable problems.
- Overestimation of the ability of medical care to cure incurable illnesses.
- Lack of alternatives: dying patients may need more care than they can receive at home and have nowhere else to go.
- The "culture" of medicine and availability of medical care: medical trainees may not learn when treatment is futile or how to de-escalate.
- Aggressive, inpatient medical care is more common in areas with more specialists and hospitals.
From 2000 to 2010, about 75% of inpatient deaths in hospitals were among patients aged 65 and over, with 25-27% aged 85 and over. The average age of patients who died during their hospital stay was 72-73 years.
