Unanticipated Death After Discharge Home From the Emergency Department

David P. Sklar, Cameron S. Crandall, Eric Loeliger, Kathleen Edmunds, Ian Paul, Deborah Helitzer

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

Study objective: We measured the frequency of unanticipated death among patients discharged from the emergency department (ED) and reviewed these cases for patterns of potential preventable medical error. Methods: This was a retrospective cohort of ED patients who were discharged to home from an urban tertiary-care facility after their evaluation, with subsequent case review. Subjects were aged 10 years and older, representing 387,334 visits among 186,859 individuals, February 1994 through November 2004. The main outcome was mortality. Deaths were assessed for relatedness to the last ED visit, whether the death was expected, and whether there was possible medical error. Deaths that were unexpected and related to the ED visit were analyzed using grounded theory to identify common themes among these cases. Error cases were identified as a subset of this group. Results: We identified and reviewed 117 patients, or 30.2 deaths within 7 days of discharge per 100,000 ED discharges home (95% confidence interval [CI] 25.2 to 36.2 deaths). Of the 117 cases, 58 (50%) were unexpected but related to the ED visit and 35 (60%) of these had a possible error. For the unexpected, related group, there were 15.0 deaths within 7 days per 100,000 discharges home (95% CI 11.6 to 19.4 deaths); for the possible error group, there were 9.0 (95% CI 6.5 to 12.6 deaths). Four themes repeatedly emerged: atypical presentation of an unusual problem, chronic disease with decompensation, abnormal vital signs, and mental disability or psychiatric problem or substance abuse that may have made it less likely that the patient would return for worsening symptoms. Conclusion: Monitoring of death records can identify unanticipated deaths after health care encounters. Further hypothesis-driven research is needed to identify, prevent, or mitigate problems in care and reduce the rate of death after ED visit.

Original languageEnglish (US)
Pages (from-to)735-745
Number of pages11
JournalAnnals of Emergency Medicine
Volume49
Issue number6
DOIs
StatePublished - Jun 1 2007
Externally publishedYes

Fingerprint

Hospital Emergency Service
Medical Errors
Confidence Intervals
Death Certificates
Mortality
Vital Signs
Tertiary Healthcare
Substance-Related Disorders
Psychiatry
Chronic Disease
Delivery of Health Care
Research

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Unanticipated Death After Discharge Home From the Emergency Department. / Sklar, David P.; Crandall, Cameron S.; Loeliger, Eric; Edmunds, Kathleen; Paul, Ian; Helitzer, Deborah.

In: Annals of Emergency Medicine, Vol. 49, No. 6, 01.06.2007, p. 735-745.

Research output: Contribution to journalArticle

Sklar, David P. ; Crandall, Cameron S. ; Loeliger, Eric ; Edmunds, Kathleen ; Paul, Ian ; Helitzer, Deborah. / Unanticipated Death After Discharge Home From the Emergency Department. In: Annals of Emergency Medicine. 2007 ; Vol. 49, No. 6. pp. 735-745.
@article{fb35c779e076405c8f4a1d377c451cb7,
title = "Unanticipated Death After Discharge Home From the Emergency Department",
abstract = "Study objective: We measured the frequency of unanticipated death among patients discharged from the emergency department (ED) and reviewed these cases for patterns of potential preventable medical error. Methods: This was a retrospective cohort of ED patients who were discharged to home from an urban tertiary-care facility after their evaluation, with subsequent case review. Subjects were aged 10 years and older, representing 387,334 visits among 186,859 individuals, February 1994 through November 2004. The main outcome was mortality. Deaths were assessed for relatedness to the last ED visit, whether the death was expected, and whether there was possible medical error. Deaths that were unexpected and related to the ED visit were analyzed using grounded theory to identify common themes among these cases. Error cases were identified as a subset of this group. Results: We identified and reviewed 117 patients, or 30.2 deaths within 7 days of discharge per 100,000 ED discharges home (95{\%} confidence interval [CI] 25.2 to 36.2 deaths). Of the 117 cases, 58 (50{\%}) were unexpected but related to the ED visit and 35 (60{\%}) of these had a possible error. For the unexpected, related group, there were 15.0 deaths within 7 days per 100,000 discharges home (95{\%} CI 11.6 to 19.4 deaths); for the possible error group, there were 9.0 (95{\%} CI 6.5 to 12.6 deaths). Four themes repeatedly emerged: atypical presentation of an unusual problem, chronic disease with decompensation, abnormal vital signs, and mental disability or psychiatric problem or substance abuse that may have made it less likely that the patient would return for worsening symptoms. Conclusion: Monitoring of death records can identify unanticipated deaths after health care encounters. Further hypothesis-driven research is needed to identify, prevent, or mitigate problems in care and reduce the rate of death after ED visit.",
author = "Sklar, {David P.} and Crandall, {Cameron S.} and Eric Loeliger and Kathleen Edmunds and Ian Paul and Deborah Helitzer",
year = "2007",
month = "6",
day = "1",
doi = "10.1016/j.annemergmed.2006.11.018",
language = "English (US)",
volume = "49",
pages = "735--745",
journal = "Annals of Emergency Medicine",
issn = "0196-0644",
publisher = "Mosby Inc.",
number = "6",

}

TY - JOUR

T1 - Unanticipated Death After Discharge Home From the Emergency Department

AU - Sklar, David P.

AU - Crandall, Cameron S.

AU - Loeliger, Eric

AU - Edmunds, Kathleen

AU - Paul, Ian

AU - Helitzer, Deborah

PY - 2007/6/1

Y1 - 2007/6/1

N2 - Study objective: We measured the frequency of unanticipated death among patients discharged from the emergency department (ED) and reviewed these cases for patterns of potential preventable medical error. Methods: This was a retrospective cohort of ED patients who were discharged to home from an urban tertiary-care facility after their evaluation, with subsequent case review. Subjects were aged 10 years and older, representing 387,334 visits among 186,859 individuals, February 1994 through November 2004. The main outcome was mortality. Deaths were assessed for relatedness to the last ED visit, whether the death was expected, and whether there was possible medical error. Deaths that were unexpected and related to the ED visit were analyzed using grounded theory to identify common themes among these cases. Error cases were identified as a subset of this group. Results: We identified and reviewed 117 patients, or 30.2 deaths within 7 days of discharge per 100,000 ED discharges home (95% confidence interval [CI] 25.2 to 36.2 deaths). Of the 117 cases, 58 (50%) were unexpected but related to the ED visit and 35 (60%) of these had a possible error. For the unexpected, related group, there were 15.0 deaths within 7 days per 100,000 discharges home (95% CI 11.6 to 19.4 deaths); for the possible error group, there were 9.0 (95% CI 6.5 to 12.6 deaths). Four themes repeatedly emerged: atypical presentation of an unusual problem, chronic disease with decompensation, abnormal vital signs, and mental disability or psychiatric problem or substance abuse that may have made it less likely that the patient would return for worsening symptoms. Conclusion: Monitoring of death records can identify unanticipated deaths after health care encounters. Further hypothesis-driven research is needed to identify, prevent, or mitigate problems in care and reduce the rate of death after ED visit.

AB - Study objective: We measured the frequency of unanticipated death among patients discharged from the emergency department (ED) and reviewed these cases for patterns of potential preventable medical error. Methods: This was a retrospective cohort of ED patients who were discharged to home from an urban tertiary-care facility after their evaluation, with subsequent case review. Subjects were aged 10 years and older, representing 387,334 visits among 186,859 individuals, February 1994 through November 2004. The main outcome was mortality. Deaths were assessed for relatedness to the last ED visit, whether the death was expected, and whether there was possible medical error. Deaths that were unexpected and related to the ED visit were analyzed using grounded theory to identify common themes among these cases. Error cases were identified as a subset of this group. Results: We identified and reviewed 117 patients, or 30.2 deaths within 7 days of discharge per 100,000 ED discharges home (95% confidence interval [CI] 25.2 to 36.2 deaths). Of the 117 cases, 58 (50%) were unexpected but related to the ED visit and 35 (60%) of these had a possible error. For the unexpected, related group, there were 15.0 deaths within 7 days per 100,000 discharges home (95% CI 11.6 to 19.4 deaths); for the possible error group, there were 9.0 (95% CI 6.5 to 12.6 deaths). Four themes repeatedly emerged: atypical presentation of an unusual problem, chronic disease with decompensation, abnormal vital signs, and mental disability or psychiatric problem or substance abuse that may have made it less likely that the patient would return for worsening symptoms. Conclusion: Monitoring of death records can identify unanticipated deaths after health care encounters. Further hypothesis-driven research is needed to identify, prevent, or mitigate problems in care and reduce the rate of death after ED visit.

UR - http://www.scopus.com/inward/record.url?scp=34249084936&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34249084936&partnerID=8YFLogxK

U2 - 10.1016/j.annemergmed.2006.11.018

DO - 10.1016/j.annemergmed.2006.11.018

M3 - Article

VL - 49

SP - 735

EP - 745

JO - Annals of Emergency Medicine

JF - Annals of Emergency Medicine

SN - 0196-0644

IS - 6

ER -