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Amenable, preventable, avoidable: untangling how senior nurses talk about mortality

Using the right terminology for different kinds of deaths will help to focus on those that could have been avoided by good quality healthcare or public health interventions
Vector illustration depicting two brains. Using the right words to describe different kinds of deaths will help focus on treatable conditions and reduce preventable mortality, says associate director of public health for North Wales Rob Atenstaedt

Using the right terminology for different kinds of deaths will help to focus on those that could have been avoided by good quality healthcare or public health interventions

In my role as a consultant in public health medicine with a focus on health intelligence and public health, I often hear senior clinicians in the NHS, including nursing staff, use the term preventable mortality to describe deaths caused by a failure to diagnose or manage a clinical condition correctly.

In other words, a failure of healthcare. I generally try to steer them towards using the term amenable mortality instead.

Amenable deaths make up

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Using the right terminology for different kinds of deaths will help to focus on those that could have been avoided by good quality healthcare or public health interventions

Vector illustration depicting two brains. Using the right words to describe different kinds of deaths will help focus on treatable conditions and reduce preventable mortality, says associate director of public health for North Wales Rob Atenstaedt
Picture: iStock

In my role as a consultant in public health medicine with a focus on health intelligence and public health, I often hear senior clinicians in the NHS, including nursing staff, use the term ‘preventable mortality’ to describe deaths caused by a failure to diagnose or manage a clinical condition correctly.

In other words, a failure of healthcare. I generally try to steer them towards using the term ‘amenable mortality’ instead.

‘Amenable’ deaths make up a sub-set of ‘avoidable’ deaths. The basic idea of avoidable mortality is that deaths caused by certain conditions, for which effective healthcare and public health interventions are available, should not occur (Office for National Statistics (ONS) 2019)

Little consensus on a definition of amenable mortality

Deaths occurring with these conditions are generally premature, before 75 years of age. The concept of avoidable mortality was first proposed more than 40 years ago by Rutstein et al (1976), who made the point then that the list of avoidable conditions would need to be revised as medical knowledge and practice improved, and social and environmental determinants changed.

Although avoidable mortality has been researched for several decades, there has been no consensus among researchers about how to define it. Fortunately, ONS (2019) has provided the following:

  • ‘Amenable mortality: a death is amenable (treatable) if, in the light of medical knowledge and technology available at the time of death, all or most deaths from that cause (subject to age limits if appropriate) could be avoided through good quality healthcare.
  • ‘Preventable mortality: a death is preventable if, in the light of understanding of the determinants of health at the time of death, all or most deaths from that cause (subject to age limits if appropriate) could be avoided by public health interventions in the broadest sense.
  • ‘Avoidable mortality: avoidable deaths are all those defined as preventable, amenable (treatable) or both, where each death is counted only once; where a cause of death is both preventable and amenable, all deaths from that cause are counted in both categories when they are presented separately.’

For amenable, or treatable, conditions it is reasonable to expect death to be averted even after the condition has developed. For example, although acquisition of tuberculosis is driven by socio-economic factors, timely treatment is effective in preventing mortality. In contrast, for preventable conditions there are effective measures that avert a given condition from occurring in the first place. For example, lung cancer is largely preventable through appropriate policies on tobacco control.

Nursing managers have a clear role in improving clinical care to reduce amenable mortality and also in decreasing preventable mortality by leading the implementation of a range of public health interventions such as the provision of smoking cessation advice to inpatients and vaccination of those at risk of infection in community settings.

Unless the terminology is right we cannot focus on improving healthcare

It could be argued that an equally important role for nursing leaders is to promote the correct use of the expressions ‘amenable’ and ‘preventable’ according to the ONS definitions and to ensure that the concept of avoidable mortality is clearly understood by NHS staff.

The words we use in our everyday practice are important because they reflect our beliefs and help shape the opinions of others. Unless we get the terminology right we cannot focus on improving healthcare, for example by decreasing levels of amenable mortality in our health organisations or by implementing public health interventions to reduce preventable mortality if high rates are found.


Picture of associate director of public health for North Wales Rob Atenstaedt, who says using the right words to describe different kinds of deaths will help to focus on conditions that are treatable and reduce preventable mortalityRob Atenstaedt is a consultant in public health medicine and associate director of public health for North Wales at Public Health Wales

 


References

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