A Study of Mortality among 6130 hospitalizations in General Medicine wards in Atertiary Care Hospital

Kingsly Robert Gnanadurai, V (2007) A Study of Mortality among 6130 hospitalizations in General Medicine wards in Atertiary Care Hospital. Masters thesis, Christian Medical College, Vellore.

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Abstract

INTRODUCTION : Today’s health-care delivery is highly complex. Care is often delivered in a pressurized and fast-moving environment, involving a vast array of technology and several individual decisions and judgements by health-care professionals. In such circumstances things can, and do go wrong. Sometimes unintentional harm comes to a patient during a clinical procedure or as a result of a clinical decision. Errors in the process of care can result in injury. Sometimes the harm caused is serious and can even be fatal. This problem of adverse events in health care is not new. There were studies done as early as the 1950s and 1960s on adverse events, but the subject remained largely neglected. A body of evidence started to emerge in the early 1990s with the publication of the results of the Harvard Medical Practice Study in 1991. Subsequent research in Australia, the United Kingdom of Great Britain and Northern Ireland (UK)4 and the United States of America (USA) and in particular the 1999 publication “To err is human: building a safer health system by the Institute of Medicine (IOM)”, provided further data and brought the subject to the top of the policy agenda and the forefront of public debate worldwide. Today more countries, including Canada, Denmark, the Netherlands, and Sweden are taking a serious look at this problem. New Zealand and Canada8 have recently published research into adverse events in public Hospitals. AIMS : To study the profile of causes of deaths among hospitalizations in General Medical wards. To perform a systematic analysis of the recorded causes and classify possible medical error related deaths. OBJECTIVES : The main objectives of the study are; 1. To study the profile of causes of deaths among hospitalizations by the general medicine units. 2. To determine frequency of occurrence of medical error related deaths and factors contributing to it. METHODS : Study design: A one-year cross-sectional study. Study setting : The study was conducted during 1st January 2005 through 31st December 2005 in The Christian Medical College Vellore. In that year there were 68,872 hospitalizations and 1,758 deaths were recorded. In the wards under general medicine units there were 6130 hospitalizations and among them 496 deaths. Study subjects : All 496 deaths occurring in the medical wards and the medical ICU were included. Study materials : Data on all in-hospital deaths such as diagnosis, elective or emergency hospitalization, duration of stay in hospital prior to death and details as mentioned in annexure 1(enclosed) were collected. The cause of death as recorded by the treating senior house officer/post graduate physician/intensivist trainee and verified by the supervising physician was noted. The cause of death is as defined by the International WHO death certificate form as the “underlying disease eventually leading to death”. The immediate cause of death is the “disorder precipitating death”. The diagnosis was coded based on system involved using the International Classification of Diseases-10 (ICD-10 WHO 2000). DISCUSSION : There were 6130 admissions in the year 2005 with a median age of 47 years and a mode of 65 years. The age distribution suggests that the majority of the admissions are in the young (12yrs - 40 yrs) and the elderly (>60yrs) populations with male predominance. Infectious diseases admissions account for majority of the admissions and among this group tuberculosis is the leading cause followed by HIV and AIDS related diseases (non tuberculous) and diarrhoeal diseases. This profile reflects the burden of infectious diseases in our country.28The second group involves the circulatory system disorders inclusive of cerebrovascular accidents. This is on par with the cause of death in the developed nations. Neoplasm or malignancy relates are only 5 % in this study while in the West it is the leading cause. The elderly28 (>60yrs) presented with mostly non-communicable diseases like complications of hypertension, diabetes, malignancies. The younger (12yrs - 40 yrs) population28 presented with tuberculosis, AIDS ands its opportunistic infections, suicidal attempts mostly with organophosphorus (OP) compounds. This disease profile also gives us an insight into the lifestyle changes that are happening with increasing incidence of non-communicable diseases and its complications. CONCLUSION : The summary of the results of this study are I. Disease burden in general medical wards in our hospital in 2005 were similar to our country’s profile with infectious disease being the leading cause. The death rate in general medical wards was 8.1%. II. a. The likely medical error related deaths occurred in 11% of all deaths in the general medical wards. b. 75% of the medical error related occurred due to system faults. Nosocomial infections(42%) are the predominant cause. c. The occurrence of a likely medical error related deaths increases as the duration of stay in hospital becomes longer than seven days.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Mortality ; 6130 hospitalizations ; General Medicine wards ; Atertiary Care Hospital.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 15 Feb 2018 17:48
Last Modified: 15 Feb 2018 17:48
URI: http://repository-tnmgrmu.ac.in/id/eprint/5726

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