Epidemiology and prevention of unexpected in-hospital deaths.

Introduction: The medical literature has only documented the importace of adverse events in terms of patient outcomes and cost to the health service over the last decade. This review focuses on the incidence, risk factors and prevention on unexpected in-hospital deaths. Discussion(s): The incidence of unexpected in-hospital deaths in the two major retrospective studies was 0.5% and 0.8% of all hospital admissions. A prospective study of surgical patients documented an incidence of nearly 7.1%. The risk factors that have been associated with hospital death include: increasing age; non-elective operative procedure; negligence; human error and unstable bedside observations in the hours prior to death. Although a number of intreventions have been suggested to prevent unexpected in-hospital deaths, very few studies have been performed to determine effectiveness. In a single institution historical control study, the introduction of a Medical Emergency Team was associated with 50% reduction in the casemix adjusted incidence of in-hospital cardiac arrest calls. Conclusion(s): There are a number of studies to suggest that in-hospital deaths are both predictable and preventable. More work is required to determine effective strategies to manage this problem.