Medical inpatient mortality at Groote Schuur Hospital, Cape Town, South Africa, 2002-2009

Abstract

Background. Despite the challenges facing healthcare in South Africa, empirical insights into the performance of healthcare services over time are scarce. Methods. We analysed first admissions of adult medical inpatients to Groote Schuur Hospital, Cape Town, from January 2002 to July 2009. Data included age, sex, medical specialty, and date of admission and discharge. We used population group and hospital billing codes as proxy measures for socio-economic status (SES). We calculated the duration of stay in days from the date of admission to discharge, and inpatient mortality rates per 1 000 patient days. Poisson regression was used to estimate mortality rate ratios (MRR) in unadjusted analysis and after adjusting for potential confounders. Annual increases in mortality rates were highest during the first 2 days following admission (increasing from 30.1 to 50.3 deaths per 1 000), and were associated with increasing age, non-paying patient status, black population group and male sex, and were greatest in the emergency ward (adjusted MRR 1.73, comparing 2009 with 2002; 95% CI 1.49 -2.01). Discussion. Increasing medical inpatient mortality rates at a large South African academic hospital were most marked during the first 2 days after admission and appeared greatest among emergency medical inpatients.

Mortality among older patients admitted to the medical wards of Groote Schuur Hospital, Cape Town, South Africa, 2010 - 2013

“…[5] A previous retrospective study (2002 -2009) carried out in the same setting as our study found a proportion of deaths of 12 -17%, although this population included young adults. [13] The proportion of deaths in the present study was higher among males than among females, though without statistical significance. This finding was not unexpected, as male sex has been reported to be an independent risk factor associated with inpatient mortality in medical wards in other studies.…”

“…This finding was not unexpected, as male sex has been reported to be an independent risk factor associated with inpatient mortality in medical wards in other studies. [5,13] Other factors that work singly or jointly have been adduced for the mortality difference between male and female older patients. [14] Older females have longer life expectancy, better health-seeking behaviour, better lifestyle habits and less exposure to stress.…”

“…[14] Advancing age has been reported as an immutable risk factor for mortality in hospitalised older patients, and our observation was no different. [5,13,15] A significant linear increase in mortality rate with increasing age was observed in both sexes. Also, there were some differences across the years of study.…”

Trends in admissions, morbidity and outcomes at Red Cross War Memorial Children’s Hospital, Cape Town, 2004 - 2013

“…[11][12][13][14][15] In SA, a recent analysis of a hospital database documented the burden on adult tertiary medical services in the Western Cape. [16] At the Chris Hani Baragwanath Hospital, Johannesburg, SA, a series of studies used discharge data to detail HIV-related disease burdens in the hospital's paediatric medical wards. [17][18][19] The Child Healthcare Problem Identification Programme (Child PIP), which uses detailed information of in-hospital child deaths in SA, provides important insights into the quality of paediatric healthcare in SA.…”

Liver cirrhosis in sub-Saharan Africa: neglected, yet important

“…How should we tackle the high burden of cirrhosis in sub-Saharan Africa, where more than 50% of patients are admitted to hospital with end-stage disease (due to poverty, limited confidence in Western medicine, trust in traditional medicine, or distance from suitable hospitals) and mortality is high at initial hospitalisation? 4 Public awareness and high-level government commitment are needed. Preventive measures must involve reliable screening of transfused blood for viral hepatitis; improved hygiene in health facilities; training or retraining of health-care workers on safe injection practices; vaccination of relatives, cohabitants, and long-term sexual partners of HBV carriers; and health promotion and education programmes to reduce alcohol consumption, excessive weight, and diabetes.…”