Study of determinants in deaths occurring in an Italian teaching hospital during a year

Introduction. The main source of mortality data is the death certificate. The forms must be filled in correctly because inaccuracy can lead to the misallocation of resources in health care programs and research. Objectives. The main purpose was to verify the existence of any relationships and/or correlations between the deaths of the Polyclinic of Bari and some specific elements by carrying out a "risk adjusted" analysis that represents a real indicator of the quality of care. Materials and methods. All death records of patients who died in the Bari Polyclinic (over 1.500 beds) in 2017 (1.005 patients) were analysed. For each card, the corresponding medical records have been evaluated. Results. The main causes of death are cardiovascular and neoplastic diseases, in line with statistics carried out on a national basis. Infectious and parasitic diseases represent the third cause of death with a discrepancy with the national average mainly due to the high incidence of nosocomial infections in European hospitals. There were no statistically significant differences in the frequency of deaths per shift and per ward. Patients suffering from infectious and digestive system diseases are more at risk of dying in the afternoon. An increased risk of death in the last hours of the night shift has been demonstrated. Discussion and conclusions. These findings indicate the need to adopt, in case of adverse events due to changes in the quality of care, the necessary barriers to prevent the occurrence of active or latent errors against patients exposed to this risk.