Cluster deaths in long-term care institutions: An investigation of excess deaths in two Ontario institutions

Objective: To review clusters of deaths in in Ontario long-term care institutions and to establish whether common etiologic factors could be identified. Method: Retrospective review of the health care records of all residents who died to assess the events leading to death and the actions of the institutions and local coroners in response to the deaths. Results: A respiratory infectious outbreak appeared to lead to many of the deaths in both institutions. Several deficiencies were identified with respect to charting practices, coroners' case investigations and institutional responses to the infectious outbreaks. No formal mechanisms were in place to assist in the early detection of cluster deaths in these institutions. Conclusions: Infectious outbreaks may be an important cause of cluster deaths in long-term care institutions. Standards should be developed for patient charting, coroners' investigations and for the prevention, identification and management of infectious outbreaks in such settings.