Every year, many patients die while undergoing treatment in the country’s hospitals. Worldwide, the death review of patients who die in hospitals is considered very important. However, it is alleged that it is not being conducted fully scientifically and properly in any healthcare institution in Bangladesh. Experts say that due to the lack of proper death review, many cases of medical malpractice remain undetected. Simultaneously, it is becoming difficult to prevent the death of the next patient and determine the correct method of treatment.
No complete and accurate statistics are available on how many patients die every year in hospitals across the country. While statistics of deaths are available in government hospitals, no one has data on private hospitals. According to the calculations of the Department of Health, at least 130,000 patients die under treatment in government hospitals alone in the country every year. However, there is no proper full clinical analysis of these deaths, and there is no national database related to it, said those concerned.
Regarding this matter, the Director-General of the Department of Health, Professor Dr. Abul Basar Mohammad Khurshid Alam, told Banik Barta, “Although death review is important, it is not available from the hospital in many cases. Outpatient, emergency department, and admission patient data and death counts are available in government hospitals, but these data are not available in private hospitals. We have asked them for information on this at various times. Death review is required to understand the disease pattern and treatment of patients. Whether the patient’s treatment was done correctly, whether there was any deficiency, this review is also useful during the treatment of the next patient. A verbal autopsy is performed after the death of the patient. However, this is not the case for all patients. And even if the autopsy is conducted, forensic pathology reviews are very few. This is done in case of unnatural death. The patient’s relatives often do not agree to the autopsy. But if a patient dies in the hospital, there should be a death review.
The scope of healthcare in the country has grown tremendously in the last few decades. The number of patients coming to the hospital for treatment has increased, and consequently, the number of deaths has also increased. According to the latest data from the Department of Health Care, the number of government hospitals across the country is 640 (excluding the Union level), and there are 7,854 private hospitals. These institutions have a total of 179,301 beds, with more than 68,000 in government hospitals and about 111,000 in private hospitals.
According to the latest data, 121,685 patients died in government hospitals in 2020. Among them, 24,500 patients were aged between 0 and 4 years, and 97,000 patients were above the age of 5 years. Patients admitted with heart failure topped the list of deaths, followed by stroke patients.
However, although government hospitals have information on patient admissions and deaths, the government does not have any information on private hospitals.
Public health experts say all hospital deaths should be reviewed. A patient’s cause of hospitalization and cause of death may not be the same. Therefore, a review of the cause of death is essential. It can detect errors in subsequent patient treatment and medical management. At the same time, the exact information on how many people are dying of any disease also comes out. That is why the issue of hospital death review is considered essential in different countries worldwide.
All deaths in the hospital should undergo a death review, said the World Health Organization (WHO) former advisor on Southeast Asia and the World Federation for Medical Education (WFME) former senior consultant Professor Dr. Mozaherul Haque. He said to Banik Barta, “Among the patients who died in the hospital, it is important to review the cause of death of any patient.” But this is not common in the country. A patient who comes to the hospital with a problem may not die because of that problem. Reviews can be of three types. One is the desk autopsy. That is, all reports related to treatment from patient admission to death will be analyzed. Another is the autopsy. That is, the patient will undergo an autopsy. All the medical documents will be given to the medical examiner. He will see if death by cause is right. The third method is death review. In this, from the concerned doctors to the nurses who were involved in the treatment of the patient, they will present an analysis.
He said, “In Bangladesh, only postmortems are conducted for non-death cases. The deaths in the country are shown to be due to corona, not all of them died due to corona. Each patient died of a different cause, but it is not known. Because there was no death review. When a hospitalized patient dies, his relatives may ask questions. Reviews are needed to investigate this. The review is useful in developing a national database of diseases and patients for the prevention of subsequent deaths due to improvements in treatment systems. The reason hospitals do not conduct this review may be that their errors will come before the public.’
Chittagong Medical College Hospital, the second-largest government healthcare institution in the country, saw the death of 13,500 patients last year. More than 270,000 patients were admitted to this 2,200-bed hospital that year. Hospital Director Brigadier General Dr. Md. Shamim Ahsan told Banik Barta, “It is not correct to say that there is no death review here at all.” Maybe it is not structurally developed. But there is a death review. Regular medical audits are done. It can review all services of the hospital on a large scale. Besides, doctors and professors review the previous day’s deaths every day in the morning session. The cause of death of the patient was discussed there.