Rate of Preventable Mortality in Hospitalized Patients: a Systematic Review and Meta-analysis

Abstract

BACKGROUND:The number of preventable inpatient deaths in the USA is commonly estimated as between 44,000 and 98,000 deaths annually. Because many inpatient deaths are believed to be preventable, mortality rates are used for quality measures and reimbursement. We aimed to estimate the proportion of inpatient deaths that are preventable. METHODS: A systematic literature search of Medline, Embase, Web of Science, and the Cochrane Library through April 8, 2019, was conducted. We included case series of adult patients who died in the hospital and were reviewed by physicians to determine if the death was preventable. Two reviewers independently performed data extraction and study quality assessment. The proportion of preventable deaths from individual studies was pooled using a random-effects model. RESULTS: Sixteen studies met inclusion criteria. Eight studies of consecutive or randomly selected cohorts including 12,503 deaths were pooled. The pooled rate of preventable mortality was 3.1% (95% CI 2.2-4.1%). Two studies also reported rates of preventable mortality limited to patients expected to live longer than 3 months, ranging from 0.5 to 1.0%. In the USA, these estimates correspond to approximately 22,165 preventable deaths annually and 7150 deaths for patients with greater than 3month life expectancy. DISCUSSION: The number of deaths due to medical error is lower than previously reported and the majority occur in patients with less than 3-month life expectancy. The vast majority of hospital deaths are due to underlying disease. Our results have implications for the use of hospital mortality rates for quality reporting and reimbursement.

Overstating inpatient deaths due to medical error erodes trust in healthcare and the patient safety movement

“…We authored a systematic review of this literature which found that 3.1% (95% confidence interval [CI], 2.2%-4.1%) of inpatient deaths were preventable, which equates to 22,165 deaths annually (95% CI, 15,730-29,315). 13 If the analysis is limited to patients with greater than 3 months life expectancy, the number is 3575-7150 preventable deaths.…”

“…A much more direct way of measuring deaths due to medical error would be to review inpatient deaths for preventability, rather than the multistage review of admissions. We authored a systematic review of this literature which found that 3.1% (95% confidence interval [CI], 2.2%–4.1%) of inpatient deaths were preventable, which equates to 22,165 deaths annually (95% CI, 15,730–29,315) 13 . If the analysis is limited to patients with greater than 3 months life expectancy, the number is 3575–7150 preventable deaths.…”

Development of Compartment Syndrome after Radial Artery Puncture in a Patient with Acute Hypoxemic Respiratory Failure due to COVID-19

“…Iatrogenic complications cause significant morbidity and mortality worldwide. A recent meta-analysis found that approximately 22,165 deaths in hospitalized patients in the United States are preventable each year [ 1 ]. In contrast, an Institute of Medicine report from 2000, “To Err is Human,” attributed roughly 98,000 in-hospital deaths per year to human error [ 2 ].…”

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“…However, despite the 2 decades since the IOM report (2000), the strategies and policy targets to address preventable harm and substandard care by international healthcare organizations appear to have remained ineffective, with patient harm in healthcare deemed as severe or life-threatening [24]. Which as Makary and Daniel, (2016) stated continues to make medical error the third leading cause of death, after cancer and cardiovascular disease [23][24][25].…”