OBJECTIVE: To investigate factors influencing
inpatient mortality and
length of stay among medical
patients at a
public hospital .
METHODS: A
case-control study involving a 10 percent sample of medical admissions
who died (n=109) was done at the Kingston Regional
Hospital during 1998. These were matched for age,
gender and admission date to 2 controls (n=180) where
death did not occur. Trained
personnel abstracted information from
personnel records .
RESULTS: The sample comprised 147
men and 139
women of mean/Standard Deviation (SD) age 61.3ñ18.1 years and range of 12 to 94 years. The mean/SD
length of stay was 6.3ñ6.0 days with a median of 5 days.
Length of stay did not differ by
gender (p=0.69) or
mortality (p=0.86). Re-admission accounted for 34.3 percent of admissions occuring at a median of 174 days. There was 70 percent agreement between the provisional
diagnosis at admission and the primary discharge
diagnosis . The commonest primary
diagnoses were
diabetes mellitus and
hypertension (14 percent each).
Stroke ,
pneumonia and
cancer each accounted for over 5 percent of primary
diagnoses .
Risk of
death was greater in
women who were alone (single or
widowed /
divorced /
separated ) than in those in a union -
odds ratio (OR) and 95 percent
confidence interval (95 percent CI) 3.63 (1.36, 9.67). In
men the OR (95 percent CI) was 0.94 (0.38-2.31).
Cancer ,
stroke chronic renal failure and
pneumonia were associated with an increased
risk of
in-hospital mortality and so was
documentation of examination by a
consultant . There was an inverse
association between the number of entries per day in
patients ' notes and the
risk of
death . Less than 2 percent of admissions had a
record of
patient satisfaction .
Nurses notes were judged to be adequate in 76.5 percent of admissions but only 19.2 percent of
patient records were rated as good overall. Good quality
records were not associated with better
survival or shorter
hospitalization .
CONCLUSION: The relationship between process of care and
inpatient mortality is complex and clear
associations were not demonstrated for overall
mortality . Cause-specific
mortality may be a more informative outcome for
quality of care studies. (AU)