Death in the Emergency Department: A Retrospective Analysis of Mortality in a Swiss University Hospital

Abstract

Acute treatment in emergency medicine revolves around the management and stabilization of sick patients, followed by a transfer to the relevant medical specialist, be it outpatient or inpatient. However, when patients are too sick to be stabilized, i.e., when the care provided in the Emergency Department (ED) may not be sufficient to enable transfer, death may occur. This aspect of emergency medicine is often overlooked, and very few public data exist regarding who dies in the ED. The following retrospective analysis of the mortality figures of a Swiss university hospital from January 1st 2013 to December 31st 2016 attests to the fact that with an incidence of 2.6/1,000, death does occur in the ED. With a broad range of aetiologies, clinical severity at presentation has a high correlation with mortality, a finding that reinforces the necessity of good triage system. Our analysis goes on to show that however (in)frequent death in the ED may be, there exists a lack of advanced directives in a majority of patients (present in only 14.8% of patients during the time of study), a worrying and often challenging situation for Emergency Medicine (EM) teams faced with premorbid patients. Furthermore, a lack of such directives may hinder access to palliative care, as witnessed in part by the fact that palliative measures were only started in 16.6% of patients during the study. The authors hope this study will serve as a stepping stone to promote further research and discussion into early identification methods for patients at risk of death in the ED, as well as motivate a discussion into the integration of palliative care within the ED and EM training curriculum.

Epidemiology of patients who died in the emergency departments and need of end-of-life care in Korea from 2016 to 2019

“…Some people die in ED from results of unexpected events or from sudden development of acute illnesses such as acute myocardial infarction or traumatic brain injury, while some patients with chronic diseases visit the ED to control rapidly worsening symptoms and serious complications of treatment and die in the ED 8 , 9 . Death during emergency care in the ED can be unavoidable for critically ill patients; however, there are little information about how many patients and who died in the ED 10 .…”

Teto terapêutico e a adequação do tratamento no Serviço de Urgência – estudo retrospectivo

“…Fica bem patente que são necessários mais esforços não só ao nível da terapêutica farmacológica, mas também ao nível de cuidados psicológicos, sociais e espirituais (15). Já que em nenhum registo há menção a estas facetas do cuidado ao doente, tal como ocorre na literatura, onde são unânimes em identificar que os serviços de urgência ficam aquém da sua responsabilidade na prestação destes cuidados (7,11,16).…”

“…O ambiente do Serviço de Urgência tem mudado ao longo do tempo, tornando-se cada vez mais exigente pela disponibilidade de novas terapêuticas e tecnologias com responsabilidades acrescidas em termos de custos, pelas equipas de profissionais subdimensionadas, que têm de assegurar a prestação de cuidados de qualidade, e pela maior afluência de uma população cada vez mais envelhecida (1,3). Sabe-se que 60-65% (4, 5) dos óbitos ocorrem em meio hospitalar e que a taxa de mortalidade no SU varia entre os 0,05%-0,47% (6)(7)(8)(9)(10)(11). Os doentes mais idosos e com maior carga de cormorbilidades constituem um desafio no SU, que supera o objetivo principal da medicina de emergência que visa avaliar o doente num curto espaço de tempo, ressuscitar, estabilizar e, finalmente, definir o destino mais adequado (2,12).…”

“…Decorrentes da limitação terapêutica, surge a implementação de cuidados paliativos no SU, que representam uma grande sobrecarga sobre os profissionais de saúde e ao próprio SU (16). A instituição de cuidados paliativos pressupõe a existência de uma doença que não responde às terapêuticas curativas e/ou com prognóstico limitado, mas não se pode assumir que o resultado é o fim de vida iminente (3,7).…”

Factors contributing to delay intensive care unit admission of critically ill patients from the adult emergency Department in Tikur Anbessa Specialized Hospital

“…Duration of hospitalization before ICU admission is an independent predictor of ICU outcome [ 9 , 10 ]. So, it is important to recognize critical illness early to enable the prompt transfer of patients who may benefit from the intensive care [ 11 – 13 ]. However, studies show that critical care in low-income countries remains a neglected field of health service provision, with large numbers of patients with potentially treatable conditions unable to receive these facilities [ 14 – 17 ].…”