Mortality meetings: ethical considerations and adherence to evidence-based practice from 6 years of experience in a mixed cardiac department.

OBJECTIVE: Most patients die unexpectedly in cardiac departments. We analyzed the ethical issues raised by poor outcomes and the leading causes of hospital deaths including organic causes of deaths, system failures, and questionable caregivers' attitudes.

METHOD: We analyzed reports from 99 mortality conferences in a mixed cardiac department (surgery and interventional cardiology) where 146 patients died from 2002 to 2008.

RESULTS: Patients were referred for cardiac surgery (n=115), interventional cardiology (n=25), or medical therapy (n=11). Highly recommended class I interventions were performed in most patients (n=120, 82%). A history of renal failure (25%), peripheral artery disease (21%), diabetes (18%), cancer (16%), or respiratory disease (16%) was frequently noticed. The areas most frequently identified as potentially problematic were preoperative strategy (58%), surgical technique (50%), monitoring (47%), reactivity (43%), drug prescription (32%), difficulties or delays in diagnosis (27%), and transfer (21%). At least one transgression from routine medical practice was identified in 66 (45%) patients, and a causal relationship between this transgression and the patient's death was suggested in 33 cases (23%). Serious errors were identified for five patients (3%), with a suggested causal relationship to death in two cases. Ethical discussions focused on alternatives in treatment (73%), good medical practice (44%), secondary recommendations (18%), information (12%), consent (12%), non-malfeasance (7%), and equity (6%).

CONCLUSIONS: Mortality conferences provide an opportunity to identify many system failures. Poor outcome is multifactorial. Technical and ethical aspects should be considered for quality care improvement.