I liked the study published this week by David Clark and Christopher Isles.
On 31st March 2010 there were 10,743 inpatients in 25 Scottish teaching and general hospitals.
One year later 3098 (29%) were dead.
That sounds a lot and is a lot. As the authors point out, the study is biased to long term inpatients as it is a prevalent sample (those in hospital) rather than an incident sample (those admitted to hospital). The latter would be more informative to us in surgery.
Another important observation: of those that died, 32% did so during the index admission.
Our acute hospitals are not set up to be good places to die. They could and should be better.
The focus of care may too often be cure, doctors treating illnesses rather than patients. We are fortunate to have excellent palliative care services within our hospital, but the recent media outrage on the Liverpool Care Pathway has left many clinicians uncertain when looking after patients at the end of life. There is no lack of compassion, but a definite of education. This must improve if care is to get better.
Finally, the study reports in the abstract and throughout that men were more likely to die than women. It is unusual that neither the authors, reviewers nor editors picked up that this statement is based on a non-significant result, odds ratio: 1.18, 95% confidence interval: 0.95–1.47. There is no gender effect in the final model.