Patients at high risk for short-term death after ED discharge identified
MedWire News: Researchers have identified patients at high risk for short-term mortality following discharge from the emergency department (ED).
Patients at increased risk for death within 7 days of discharge from the ED include the elderly, males, and individuals with comorbidities.
The results highlight an important public health problem and deserve more scrutiny to determine if these deaths can be anticipated and prevented, write Gelareh Gabayan (University of California, Los Angeles, USA) and colleagues in the Annals of Emergency Medicine.
The team explains that although efforts have been made to improve patient safety in emergency care, the ED is a high-risk setting. Approximately 30,000 patients die annually in the USA following ED discharge, suggesting that this still remains a rare outcome.
Efforts are needed, however, to understand patterns and predictors of short-term death following discharge if hospitals are to reduce the risk for such events, say the researchers.
Gabayan and colleagues used administrative data from 12 US hospitals to identify 475,829 patients admitted to the ED in 2007 and 2008. During this time, there were 728,312 discharges from the ED. Patients outside the healthcare system and those in hospice care were excluded from the analysis.
Death within 7 days of discharge from the ED occurred in 357 cases (0.05%). The average age of patients who died was 71 years and more than 25% of these individuals had at least one serious or chronic condition, including a previous myocardial infarction, congestive heart failure, or vascular, pulmonary, or renal disease.
Older patients and men were at an increased risk for early death following hospital discharge, as were patients with comorbidities.
Multivariate analysis revealed that individuals diagnosed with noninfectious lung disease (odds ratio [OR]=7.1), renal disease (OR=5.6), and ischemic heart disease (OR=3.8) were at a significantly increased risk for death following discharge.
Individuals with neoplasm (OR=3.7) and those with diseases of the blood (OR=3.6), including anemia and sickle cell disease, were also at a significantly increased risk for short-term mortality.
Extrapolating the 0.05% event rate to the more than 80 million discharges from the ED in the US each year suggests that 41,500 patients die within 7 days of being released from hospital, say the researchers.
This rate is significantly higher than previously reported, possibly due to older, more complex patients included in the database, they add.
The team concludes that further research is needed to identify "clinical scenarios, medical decisions, or health system actions that can be used to design quality improvement initiatives."
By MedWire Reporters