Mortality soon after discharge from a major teaching hospital: linking mortality and morbidity

In this pilot study, data held by the Registrar of Births, Deaths and Marriages was linked to the Patient Master Index at St Vincent's Hospital Melbourne in order to identify early post discharge deaths, and inpatient records were linked with the Victorian Inpatient Minimum Database. Between July 1991 and December 1993 there were 831 deaths within 28 days of discharge. Injuries and poisoning were the commonest cause of death in younger patients who had attended the emergency department. These were responsible for 64% of deaths under the age of 40 years. There were deaths from cardiovascular disease which had been unrecognised during the hospital stay. There is also the need to identify in hospital those at risk of suicide. Amongst inpatients who were discharged home or transferred, the risk of death was greatest in the days immediately following discharge. Policies relating to the transfer of patients need to be reviewed as the study found that 30% of patients who had been transferred to long term care facilities died within four days. In conclusion, linking mortality and morbidity data can highlight areas of hospital care where there is the potential to prevent premature death, and improve management. The outcome of coronial investigations should be transmitted to hospitals for quality assurance purposes.