Hospitals provide inadequate medical care in 40% of overdose deaths

Almost 40 per cent of people admitted to hospital after taking an overdose received sub-standard care that may have contributed to their death, a new study by researchers at the Universities of Manchester and Bristol has found.

Professor David Gunnell of Bristol’s School of Social and Community Medicine and colleagues at The University of Manchester's Centre for Suicide Prevention looked at all patients who died in English hospitals in 2005 following an overdose.

"We found that in as many as 39 per cent of cases of self-poisoning fatalities in hospitals, the medical care received may have been in some way sub-optimal," said Professor Nav Kapur, who led the research.

"The commonest reason for poor care was inadequate airway management and in the majority of cases the deficiencies in medical care potentially contributed to the patient's death."

The research team, which also included experts from the Royal Infirmary of Edinburgh and the University of Oxford, obtained information on 121 cases.

The cases were assessed by an expert panel, which rated each case with respect to quality of care and likely contribution to the fatal outcome.

Individuals who died were almost twice as likely to have care rated as inadequate as a comparison group who did not die.  Poor care was more common in those aged 50 years and over with older patients less likely to be intubated or moved to high-dependency or intensive-care units.

Suicide by self-poisoning is a major cause of death worldwide and in England and Wales accounts for more than 1,200 deaths a year or about a quarter of all suicides.  Based on the team's findings, about 200 of these individuals who take fatal overdoses in England survive long enough to reach hospital.

"The causes of poor care in what amounts to over a third of these cases are complex and our research suggests that no single intervention is likely to improve outcomes," said Professor Gunnell.

"Previous work has suggested that guidelines, training, seeking appropriate advice, audit and case reviews may all prove helpful in improving the quality of care for these patients."

The study is published this week in the Quarterly Journal of Medicine (QJM).