The  skill  and  knowledge  of doctors affect  the in-hospital mortality.

   Recent documented studies in this regard is scant. In this study in-hospital

   mortality  of   patients   at  Ghaem  children’s  hospital  -  Hamadan  for  6

   consequent years (1989-1995) was investigated.

         In the  first 3 - year (1st p) patients were  firstly managed by the interns

   who worked under  supervision of an in-hospital GP. In the second 3-year

   (2nd p) a  full  time  residency  was  established  in  the  hospital  and  the

   patients  were  firstly  handled by the residents. In both periods an on-call

   service   of   the   attending   pediatricians   was   available  .

         Number of admissions   in   1st p  and   2nd p  were   5804   and   5663

   respectively .  Number   of   deaths  in 1st p  were  735  and  in  2nd p 309.

   Number of deaths in the first day after admission in 1st p were 448(7.6% of

   admissions)and  in 2nd p125(2.4% of admissions). Number of deaths after

   the  1st  day  of  admission in 1 st p were 287and in 2nd p 184. Distribution 

   of the   patients  by sex , age , causes  of death, dwelling area, maternal

   education ,weight for age, duration of  admission  was not  considerably

   different in both periods. Number of  the  attending medical staff, nurses,

   and  also  the  therapeutic  and   paramedical   facilities  were  similar  in 

   both  periods.

         Reduction  in  mortality  rate  was conspicuously more in  the 1st  day

   after admission and less in the neonatal period.

         Higher quality of medical services lowers hospital mortality.