The potentially avoidable mortality in hospitals has remained the same compared to 2015/2016. In 2019, approximately 1018 patients died partly due to care-related harm that could probably have been prevented. Previously, this potentially avoidable mortality in hospitals had fallen sharply, partly due to the introduction of the national patient safety program (VMS). Additional efforts are needed to further improve patient safety in hospitals. This is evident from research by Nivel and Amsterdam Public Health research institute (APH).

The fifth measurement of healthcare related harm shows that in one year 3.1% of the patients who died in hospital had to deal with potentially avoidable mortality. This means that patients have died partly because something in the treatment or care process did not go well. Compared to the previous measurement in 2015/2016, the extent of the potentially avoidable mortality has remained the same.

"We would prefer to see the potentially avoidable mortality decrease even further. A possible explanation for staying the same and not further decreasing the potentially avoidable mortality is the increase in more complex patients in the hospital. They are over 70 years of age, have been admitted unplanned, and have five or more underlying conditions." - Prof. dr. Cordula Wagner,
Professor of Patient Safety.

Healthcare related harm is an unintended outcome of a treatment with harm to the patient. Often these are known risks of a specific treatment. Healthcare related harm increased in 2019 compared to 2015/2016. This increase is in high-risk treatments, but also side effects with intensive chemotherapy. In addition, it concerns complications such as a tear or hole in the intestinal wall during a procedure or infections with implants. The risks of complications cannot always be avoided, but must be noticed quickly, otherwise the situation may get worse and potentially avoidable harm and death may occur.

Tackling opportunities for improvement together

Hospitals, medical specialists and nurses can jointly take up the opportunities for improvement that come from the research. For example, extra attention is needed in the care of vulnerable elderly people. Several care providers are often involved in the provision of care at the same time, which makes care complex. Opportunities for improvement lie in regularly reflecting on what is and is not going well, possibly together with patients and relatives, the multidisciplinary conversation between healthcare providers and quality assurance. There are also points for improvement in the field of medication safety, such as monitoring when using anticoagulants.

Positive developments

The administration in the new electronic health records has become increasingly complete and is now at a high quality level. This is an important condition for safety if patients are treated by different healthcare providers. It is also increasingly possible to find in the files which considerations doctors and patients have made together.

Can potentially avoidable mortality be reduced?

The occurrence of potentially avoidable harm and mortality often has multiple causes. These are human, organizational, technical and patient-related causes.

"Preventing harm is not just about improving the clinical conduct of healthcare providers. It is also about the hospital organization. It is about stimulating a proactive safety culture, multidisciplinary collaboration in the care chain, involving patients in (treatment) decisions and supporting the adaptability and
resolution capacity of healthcare providers and the organization," says Wagner. 

The new national safety programme of hospitals 'Time for connection' is promising in this respect. The ambition of the programme is to reduce the potentially avoidable mortality, something that can become visible in a subsequent measurement.

The research

The results are based on the fifth measurement of the healthcare related harm monitor, carried out by the Nivel and Amsterdam Public Health Research Institute of Amsterdam UMC with a subsidy from the Ministry of Health, Welfare and Sport. Twenty randomly selected hospitals participated in the study. These were academic, top clinical and general hospitals. In total, nearly three thousand patient records were examined of patients who died in hospital in 2019. This is about ten percent of all patients who died in the hospital in 2019. The patient records have been examined by independent and trained nurses and medical specialists.

This research has only been possible due to the openness of the participating hospitals. The Netherlands is the only country in Europe where a national patient record survey is periodically conducted into patient safety in hospitals.

Contact persons

Cordula Wagner, Bo Schouten and Martine de Bruijne