Perspectives of Hospital Mortality of Intensive Cares in Public Urban Hospitals Manisa in Turkey, Based on a One-Year Review

Analysis of hospital mortality helps to assess the standards of health care delivery. The causes of death were coded according to the International Statistical Classification of Diseases. The causes of death were classified according to the International Statistical Classification of Diseases (ICD-10). Chi square was used to analyze. All statistical analyses were performed using the Statistical Package for the Social Sciences, Version 11 (SPSS). Of the 21,739 patients who were discharged, 300 (1.3%) died. Males constituted 60.7% and females 39.3%. The six most common ICD-10 chapters, IX, X, XIV, II, VI, and XI, included 76.4% of the total 300 deaths. Several important issues in intensive cares were raised. Disease specific characteristics, as well as functional and infrastructural inadequacies, were identified and provided evidence for defining priorities and strategies for improving the standards of nursing care. Effective transformation can promise better prospects. Categories: Internal Medicine, Medical Education, Epidemiology/Public Health


Introduction
Hospital mortality is a traditional indicator for hospital performance, and under conditions in which death is not a rare event, it is a useful tool for indicating services that may present quality problems. Differences in mortality rates that are found between hospitals may occur as a function of the severity profile of the population attended. Thus, this indicator needs to be controlled and adjusted in relation to variables that might affect the result, the residual differences being the indicator for the quality of care [1][2].
ICD-10 was endorsed by the Forty-Third World Health Assembly in May 1990 and came into use in WHO Member States as of 1994. The classification is the latest in a series that has its origins in the 1850s. The first edition, known as the International List of Causes of Death, was adopted by the International Statistical Institute in 1893. WHO took over the responsibility for the ICD at its creation in 1948 when the Sixth Revision, which included causes of morbidity for the first time, was published. The World Health Assembly adopted in 1967 the WHO Nomenclature Regulations that stipulate use of ICD in its most current revision for mortality and morbidity statistics by all Member States [3].
The International Classification of Diseases and Health Problems 10th revision (ICD-10) is a standard for classifying diagnoses, symptoms, and other medical care encounters [4][5]. Reliable 1 encoding of diagnoses is of high medical and epidemiological importance. The increasing importance of the imaging of patients' morbidity is shown by the fact that reimbursement in Turkey's ambulatory healthcare system became morbidity-based. Besides age and gender, ICD-10 coded diagnoses will be the basis for this reimbursement; thus, their exact coding will be of existential relevance. There are three volumes of the ICD-10: Volume 1: Tabular list, Volume 2: Instruction manual, and Volume 3: Alphabetical index. The 21 chapters are subdivided into homogenous ''blocks'' of three alphanumeric character categories. This is the ''core'' classification of ICD-10. The four-character subcategories are recommended for many purposes and form an integral part of the ICD, as do the special tabulation lists [4,[6][7]. As of July 1, 2005, it became compulsory for health institutions in Turkey to use the ICD-10 [8].
The purpose of this study was to examine the distribution of deaths in the intensive care unit according to ICD-10 classification.

Materials And Methods
This is a retrospective cohort study evaluating the causes of deaths which occurred during the years 2008 January 1 to 2007 January 1 in single hospitals. The hospitals involved in this study were the Center Government Hospital, the Merkez Efendi Government Hospital, and Children's Hospital. The data of the study was obtained from the electronic database of each hospital. The causes of death were coded according to the International Statistical Classification of Diseases. The causes of death were classified according to the International Statistical Classification of Diseases (ICD-10) [6][7]. All statistical analyses were performed using the Statistical Package for the Social Sciences Version 11 (SPSS). Chi square was used to analyze.

Ethics
The study is based on a past-year examination of archival records and written permission was obtained between the Provincial Directorate of Health and hospital administrations. The patient names and protocol numbers of data used in the study are not disclosed.

TABLE 3: Classification of the causes of death according to ICD-10
The highest death rates occurred in the cardiology intensive care unit (32.7%) and the intensive care unit (5.7%) (
In 1999, Deb S. published "ICD-10 codes detect only a proportion of all head injury admissions," where a year's records between 1997 and 1998 were examined [8]. Most injuries were the age group of 18-65. Classification using ICD-10 codes were found to be more than 50% of head injuries. He determined that 46% of the hospital patients stayed 24-48 hours [8]. This study examined the experiences of spouses of patients with ICD-10 in 2004, six female and two male patients were almost askantitif experiences. The mean age of 52, respectively. The patients' relatives of uncertainty, insecurity, and the patient had decreased protective behaviors. ICD to improve the efficiency and progress of education and psychological interventions aimed to support and strengthen the study [10].
Wockenfuss R, et al. "by the 3-4 digit ICD 10 codes for primary care classification system is not reliable" by cross sectional studies between 1999 and 2000 planned. ICD-10 sections of problems to be reliable and 34 digit codes to encode the uncertainties caused by the primary care terminology simplification should not be trusted to achieve realistic results were observed [5].

Conclusions
Several important issues in intensive cares were raised. Disease specific characteristics, as well as functional and infrastructural inadequacies, were identified and provided evidence for defining priorities and strategies for improving the standards of nursing care. Effective transformation can promise better prospects.

Additional Information Disclosures
Human subjects: Consent was obtained by all participants in this study. The Provincial Directorate of Health and hospital administrations issued approval N/A. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.