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Clinicians' perception of the preventability of inpatient mortality

Nash, R; Srinivasan, R; Kenway, B; Quinn, J; (2018) Clinicians' perception of the preventability of inpatient mortality. International Journal of Health Care Quality Assurance , 31 (2) pp. 131-139. 10.1108/IJHCQA-06-2016-0083. Green open access

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Abstract

PURPOSE: The purpose of this paper is to assess whether clinicians have an accurate perception of the preventability of their patients’ mortality. Case note review estimates that approximately 5 percent of inpatient deaths are preventable. DESIGN/METHODOLOGY/APPROACH: The design involved in the study is a prospective audit of inpatient mortality in a single NHS hospital trust. The case study includes 979 inpatient mortalities. A number of outcome measures were recorded, including a Likert scale of the preventability of death- and NCEPOD-based grading of care quality. FINDINGS: Clinicians assessed only 1.4 percent of deaths as likely to be preventable. This is significantly lower than previously published values (p<0.0001). Clinicians were also more likely to rate the quality of care as “good,” and less likely to identify areas of substandard clinical or organizational management. RESEARCH LIMITATIONS/IMPLICATIONS: The implications of objective assessment of the preventability of mortality are essential to drive quality improvement in this area. PRACTICAL IMPLICATIONS: There is a wide disparity between independent case note review and clinicians assessing the care of their own patients. This may be due to a “knowledge gap” between reviewers and treating clinicians, or an “objectivity gap” meaning clinicians may not recognize preventability of death of patients under their care. SOCIAL IMPLICATIONS: This study gives some insight into deficiencies in clinical governance processes. ORIGINALITY/VALUE: No similar study has been performed. This has significant implications for the idea of the preventability of mortality.

Type: Article
Title: Clinicians' perception of the preventability of inpatient mortality
Open access status: An open access version is available from UCL Discovery
DOI: 10.1108/IJHCQA-06-2016-0083
Publisher version: https://doi.org/10.1108/IJHCQA-06-2016-0083
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Clinical audit, Clinical indicators, Health and safety
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry
URI: https://discovery.ucl.ac.uk/id/eprint/10049451
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