Skip to main content

Main menu

  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us

Clinical Medicine Journal

  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

User menu

  • Log in

Search

  • Advanced search
RCP Journals
Home
  • Log in
  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us
Advanced

Clinical Medicine Journal

clinmedicine Logo
  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

Unexpected deaths following discharge of medical patients from hospital

Vedamurthy Adhiyaman and Indrajit Chattopadhyay
Download PDF
DOI: https://doi.org/10.7861/clinmed.2019-0306
Clin Med November 2019
Vedamurthy Adhiyaman
Glan Clwyd Hospital, Rhyl, UK
Roles: Consultant geriatrician
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: vedamurthy.adhiyaman@wales.nhs.uk
Indrajit Chattopadhyay
Glan Clwyd Hospital, Rhyl, UK
Roles: Consultant geriatrician
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Info & Metrics
Loading

Introduction

Unexpected death of a patient shortly following discharge from hospital is one of the worst nightmares for a clinician who had been involved in the discharge decision. Indeed, any adverse event post discharge could be stressful for the patients and the clinical team.1 Though there is data on hospital readmission rates and post-discharge adverse events, we do not have data on the incidence of unexpected deaths following discharge of medical inpatients.2–4 Hence, we undertook a prospective observational study to estimate the incidence of deaths within 72 hours of discharge from the acute hospital.

Methods

The study was performed at a district general hospital serving a population of over 220,000. We sought permission from the hospital's medical directorate and the senior coroner for North Wales. This study complemented the hospital's routine mortality reviews.

We identified patients who died within 72 hours of discharge through the hospital's bereavement office and the coroner's office.

We only included deaths following discharge from the medical teams. We excluded deaths following emergency department attendance, anticipated deaths (end-of-life care), deaths in community hospitals following transfer from the acute site and deaths following non-medical specialty discharges.

Results

Over 16 months (March 2018 – June 2019), nine unexpected deaths occurred within 72 hours of discharge from the medical teams. During that period, there were around 13,000 medical discharges, giving an incidence of 0.06–0.07% or around one death per 1,300 discharges.

The mean age of the patients was 68 years (range 34–88 years; eight males and one female). Eight patients were discharged by consultants and one by a middle grade trainee. The average duration between discharges to death was 1.2 days (a few hours to 2 days). The mean pre-discharge National Early Warning Score (NEWS) was 1.7 (0–5). The average length of stay before discharge was 7 (0–15) days.

All cases were discussed with the coroner, and five patients underwent post-mortem examination. For the other four patients, clinicians were able to provide a death certificate. Only one discharge was deemed to be unsafe. Except for one patient, the rest had multiple comorbidities and the death didn't come as a surprise.

The primary causes of death.

  • Ruptured aortic aneurysm.

  • Metastatic cancer (known diagnosis).

  • Myocardial infarction/coronary artery disease (two cases).

  • Cardiac arrhythmia.

  • Cardiac failure.

  • Bronchopneumonia.

  • Pulmonary embolism.

  • Drug overdose (known abuser).

Discussion

From our study, the risk of unexpected death following discharge from acute hospital medical wards is around 1 in 1,300. Since there is no published data, we were unable to compare our figures with other regions and countries. All deceased patients were discharged by a senior doctor and the NEWS was low in many of them.

While it is reassuring that unexpected mortality following discharge of medical inpatients is low, it does happen regularly and bound to very stressful. This data would be very useful when discussing such risks with patients, families, coroners, litigation and legal services and for the wider governance structure. Clinicians should keep clear and accurate records when discharging patients as these will be crucial to defend and reflect on decisions and actions when such unexpected adverse incidents occur.

  • © 2019 Royal College of Physicians

References

  1. ↵
    1. Oliver D.
    The stress of sending patients home. BMJ 2019;365:I2094.
    OpenUrl
  2. ↵
    1. NHS Digital
    . Emergency readmissions published for first time in five years. NHS, 2019. https://digital.nhs.uk/news-and-events/latest-news/emergency-readmissions-published-for-first-time-in-five-years.
  3. ↵
    1. Forster AJ
    , Murff HJ, Peterson JF, Gandhi TJ, Bates DW. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med 2003;138:161–7.
    OpenUrlCrossRefPubMed
  4. ↵
    1. National Institute for Health and Care Excellence
    . Chapter 35 Discharge planning: Emergency and acute medical care in over 16s: service delivery and organisation: NICE guideline 94. NICE, 2017. https://www.nice.org.uk/guidance/ng94/evidence/35discharge-planning-pdf-172397464674.
Back to top
Previous articleNext article

Article Tools

Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Citation Tools
Unexpected deaths following discharge of medical patients from hospital
Vedamurthy Adhiyaman, Indrajit Chattopadhyay
Clinical Medicine Nov 2019, 19 (6) 531; DOI: 10.7861/clinmed.2019-0306

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Unexpected deaths following discharge of medical patients from hospital
Vedamurthy Adhiyaman, Indrajit Chattopadhyay
Clinical Medicine Nov 2019, 19 (6) 531; DOI: 10.7861/clinmed.2019-0306
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Introduction
    • Methods
    • Results
    • Discussion
    • References
  • Info & Metrics

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Promoting electric vehicle uptake, a job for the NHS?
  • A HaemSTAR is born; a trainee-led, UK-wide research network in haematology
Show more Clinical and scientific letters

Similar Articles

Navigate this Journal

  • Journal Home
  • Current Issue
  • Ahead of Print
  • Archive

Related Links

  • ClinMed - Home
  • FHJ - Home
clinmedicine Footer Logo
  • Home
  • Journals
  • Contact us
  • Advertise
HighWire Press, Inc.

Follow Us:

  • Follow HighWire Origins on Twitter
  • Visit HighWire Origins on Facebook

Copyright © 2020 by the Royal College of Physicians