Hospitals provide inadequate medical care in 40% of overdose deaths

Almost 40% of people admitted to hospital after taking an overdose received sub-standard care that may have contributed to their death, a new study has found.

Researchers at The University of Manchester’s Centre for Suicide Prevention looked at all those in England who died in hospital following an overdose over a 12-month period.

“We found that in as many as 39% 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 included experts from the Royal Infirmary of Edinburgh and the Universities of Oxford and Bristol as well as Manchester, 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,” said Kapur, Professor of Psychiatry and Population Health.

“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 Kapur.

“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, ‘Self-poisoning suicide deaths in England: could improved medical management contribute to suicide prevention?’ is published in the Quarterly Journal of Medicine (QJM).