Jordan Ellis
While many people pass away at home or elsewhere, hospitals are one of the most common places of death. According to a recent study, approximately 35.1% of people die in hospitals. This figure has decreased from 48% in 2000, with a rise in deaths at home and in long-term care facilities. While not all hospital deaths are preventable, medical errors are a leading cause of death and injury, with sepsis being the leading cause of death in hospitals.
| Characteristics | Values |
|---|---|
| Percentage of deaths occurring in hospitals | 35.1% |
| Number of deaths in hospitals in the US | 700,000-800,000 |
| Number of deaths due to medical errors | 44,000-440,000 |
| Number of deaths due to medication errors | 7,391 (in 1993) |
| Percentage of inpatient deaths due to medication errors | 2.37-fold increase over 10 years |
| Percentage of deaths that could have been prevented | 14-27% |
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What You'll Learn
Preventable deaths in hospitals
While the number of people who have died in hospitals is difficult to pinpoint, it is estimated that about one-third of all deaths occur in hospitals in the United States. This amounts to over 700,000 people dying in hospitals each year in the US. However, the trend is towards fewer in-hospital deaths, with the CDC reporting an 8% drop in hospital deaths from 776,000 to 715,000.
The pooled rate of preventable mortality is 3.1%, translating to approximately 22,165 preventable deaths annually in the USA. However, it is important to note that the vast majority of hospital deaths are due to underlying diseases, and preventable deaths are more common in patients with a life expectancy of less than three months.
Medical errors, such as misdiagnosis, drug dosage miscalculations, and treatment delays, are a leading cause of preventable deaths in hospitals. These errors can have devastating consequences, including permanent injury or death. It is estimated that more than 250,000 people may die from medical errors each year in the USA, with some studies placing the figure at 440,000.
The reduction of preventable deaths in hospitals is a critical focus area. Hospitals have implemented active error-reduction programs, and medical care is constantly improving through research. These efforts are expected to contribute to a further decrease in in-hospital deaths.
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Medical malpractice
One study by John Hopkins Medicine estimated that over 250,000 people in the U.S. die annually from medical errors, making it the third-leading cause of death after heart disease and cancer. However, some studies suggest the death toll could be as high as 440,000, while others place it at around 100,000. The discrepancy in numbers may be attributed to varying definitions of medical errors, methodologies, and populations studied.
Medical errors can take many forms, including wrong diagnoses, drug dosage miscalculations, treatment delays, surgical complications, and medication errors. These errors may arise from inadequately skilled staff, errors in judgment or care, system defects, or preventable adverse effects. For instance, a patient may experience a preventable adverse event due to a computer breakdown or a mix-up with medication dosages. In one tragic case, a two-year-old girl named Emily Jerry lost her life after a pharmacy technician filled her intravenous bag with more than 20 times the recommended dose of sodium chloride.
The impact of medical malpractice extends beyond the immediate harm to the patient. It can have profound emotional and financial repercussions for the patient's family, who may be left confused and grieving. In such cases, survivors may be entitled to significant financial compensation through wrongful death claims or malpractice lawsuits. However, the process can be complex, and specific guidelines and time constraints must be followed when pursuing legal action.
To address the issue of medical malpractice, advocates are pushing for greater patient safety legislation. Additionally, hospitals are increasingly adopting new technologies, such as computerized physician order-entry programs and electronic health records, to improve patient safety and reduce errors. While these measures are a step in the right direction, the healthcare system must continue to prioritize patient safety and work towards preventing future errors.
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Misdiagnosis
The impact of misdiagnosis extends beyond the harm caused to individual patients. The economic burden of misdiagnosis is also significant, with the total costs estimated to be in the billions of dollars. These costs arise from factors such as the additional medical expenses associated with treating misdiagnosed conditions, lost productivity due to premature deaths or disabilities, and the societal impact on families and communities.
Certain diseases have been identified as having the highest risk of serious harm from misdiagnosis. These include stroke, sepsis, pneumonia, venous thromboembolism, and lung cancer. Stroke alone accounts for about 94,000 serious harms each year due to misdiagnosis. Other conditions with high misdiagnosis rates include spinal abscess, with an error rate of over 60%, and heart attacks, which have a lower error rate of less than 2%.
Racial and gender disparities also exist within the realm of misdiagnosis. Studies have found that women and racial and ethnic minorities are 20% to 30% more likely to receive a misdiagnosis than white men. This disparity cannot be solely attributed to differences in insurance coverage and access to quality healthcare. Implicit racial and gender biases among healthcare professionals likely contribute to these disparities, highlighting the urgent need for increased awareness and efforts to reduce bias in medicine.
While the issue of misdiagnosis is widespread and concerning, it is important to note that the exact number of deaths and disabilities caused by misdiagnosis is challenging to determine. Many cases of misdiagnosis may go undetected or unreported, leading to underestimates or overestimates in the available data. Nonetheless, the significant impact of misdiagnosis on patient safety and public health underscores the imperative for continuous improvement in diagnostic accuracy and equity in healthcare.
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Medication errors
While the number of patient deaths due to medical errors is controversial, with estimates ranging from 22,000 to over 400,000 in the US alone, it is clear that medication errors contribute significantly to these numbers. A study of 366 patients admitted to a cardiology department found that 15 admissions were due to definite or probable drug events, with five judged as errors in prescription. In another study, 441 medication errors were reported for 682 children admitted to a Congenital Heart Disease Centre, with 68% attributed to prescribing errors.
To address this issue, the WHO launched "The Third Global Patient Safety Challenge: Medication Without Harm" in 2017. This initiative aims to eradicate medication errors and improve patient safety. Additionally, organisations like the ECAMET Alliance are advocating for regulations and guidelines on medication traceability to prevent medication errors in Europe.
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Patient preferences
While the number of hospital deaths in the United States has decreased, hospitals remain a common place of death. However, patient preferences often lean towards dying at home or in a community-based setting. This shift in preference is reflected in the growing "have the conversation" movement, which encourages discussions about end-of-life care and treatment wishes in the event of a terminal illness.
Research indicates that most Americans prefer to die at home rather than in a hospital. A 2018 study found that compared to 2000, when 33% of deaths occurred at home, the number of people dying at home in 2015 increased to 40%. Additionally, the percentage of deaths in acute care hospitals decreased from 33% in 2000 to 20% in 2015. This trend is also observed in Italy, where about 50% of patients die in acute care hospitals, and many seriously ill patients initially choose to be cared for at home.
Several factors influence patient preferences for end-of-life care and dying. One significant factor is the recognition that inpatient treatment may not always be the best option, especially in terminal illnesses. Patients and their doctors are increasingly aware that inpatient treatment might be futile, and the focus shifts to prioritizing quality of life over its length. This is particularly relevant for conditions known to be terminal, such as certain types of cancer, where there is an opportunity to plan ahead and make informed decisions about the type and location of treatment.
Another factor influencing patient preferences is the availability and acceptability of alternative care sites, including hospice settings. The percentage of deaths occurring in long-term care facilities, such as hospices, nursing homes, or assisted living facilities, has increased. This trend is particularly notable for patients with specific conditions, such as cancer, who have higher odds of dying at home or in a hospice facility. Additionally, patients with cardiovascular disease have lower odds of death in a hospice facility, while those with respiratory disease have higher odds of death in a hospital.
While patient preferences play a crucial role in end-of-life care, it is important to acknowledge that not everyone can or wants to die at home. For some, dying at home may not be a feasible or desirable option. Additionally, the unpredictability of death and the potential for sudden complications can lead to hospitalizations, even for those who initially choose home-based care. Furthermore, aggressive and intensive medical interventions in hospitals may prolong life, but they can also result in patients being transferred to nursing homes with severe disabilities and a poor quality of life.
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Frequently asked questions
35.1% of all deaths occurred in hospitals in 2018.
It is difficult to give an exact number due to the varying accuracy of hospital cause-of-death data. However, a study in Switzerland between 2010 and 2012 recorded 47,311 deaths from hospital discharge statistics.
Hospitals record causes of death through civil registration and certification by a qualified physician based on the International Classification of Diseases (ICD).
Hospital cause-of-death statistics are used to review health priorities, set research agendas, and monitor progress toward health and development goals.
