Out-of-hours primary care and the patients who die. A survey of deaths after contact with a suburban primary care out-of-hours service.

OBJECTIVE: To assess how and to what extent out-of-hours primary care facilities care for patients who die shortly afterwards, and whether information about deaths and causes of deaths are fed back to doctors who treated the deceased persons.
DESIGN: An observational prospective study of patients who die.
SETTING: An out-of-hours primary care facility providing services to a population of 78,000.
SUBJECTS: 531 patients who died in the 1-year study period. MAIN OUTCOME MEASURES: Extent of reporting back about deaths to the out-of-hours primary care facility and description of contacts with out-of-hours primary care prior to death.
RESULTS: 134 of 531 deceased patients had been treated by an out-of-hours primary care physician within the last 4 weeks of life. The physicians had received information about the cause of death in only 9 of the cases (6%). Six dead patients (5%) had their condition misinterpreted by the out-of-hours primary care physicians, with a possible delay in appropriate care.
CONCLUSION: Prompt feedback of causes of death to primary care physicians represents an important, but mostly unexploited, potential for quality improvement.