Death within 8 days after discharge to home from the emergency department

Gunnarsdóttir, Oddný Sigurborg; Rafnsson, Vilhjálmur

doi:10.1093/eurpub/ckn045

Cited by 20 publications

(30 citation statements)

References 6 publications

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“…6 These rates are dramatically lower then rates reported in a study conducted in Iceland (0.2% or 208 in 100,000) most likely due to the difference in the health care system, the patient population, and the reliability of the national registry. 7 Our study found the three most common causes of short-term death in patients discharged from the emergency department to be malignancy (19.6%), coronary heart disease (17.3%), and non-atherosclerotic heart disease (11.3%), which includes peri-, endo-, or myocarditis, cardiomyopathy, dysrythmia, pulmonary heart disease and valve disorder. These findings are similar to national statistics in which the most common cause of death in all individuals is due to diseases of the heart (26%) and malignancy (23%).…”

Section: Discussionmentioning

confidence: 62%

“…We chose the 7-day time frame because of its clinical relevance, implications for health policy decisions, and prior use in previous studies. 4-7 Mortality data included the California vital statistics files for in-state deaths and the Social Security Death Index for out-of-state deaths. Occurrence of death was determined within the year of the ED visit regardless of subsequent health plan membership status.…”

Section: Methodsmentioning

confidence: 99%

“…4-5 Studies of this phenomenon conducted in Iceland and Canada may not be generalizable to the US population due to differences in healthcare systems and populations. 6-7 The major barrier to studying this important public health problem in the United States has been the lack of large datasets that link information about patient co-morbidities, acute ED illness presentation, and ED care to post-ED discharge outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Patterns and Predictors of Short-Term Death After Emergency Department Discharge

Gabayan

Derose

Asch

et al. 2011

Annals of Emergency Medicine

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Objective The emergency department (ED) is an inherently high-risk setting. Early death after an ED evaluation is a rare and devastating outcome which the understanding of can potentially help improve patient care and outcomes. Using administrative data from an integrated health system, we describe characteristics and predictors of patients who experience 7-day death after ED discharge. Methods Administrative data from 12 hospitals were used to identify death after discharge in adults age 18 or older within 7 days of ED presentation from 1/1/07 to 12/31/08. Patients who were non members of the health system, in hospice care, or seen at out of network EDs were excluded. Predictors of 7-day post-discharge death were identified using multivariable logistic regression. Results The study cohort contained a total of 475,829 members with 728,312 discharges from Kaiser Permanente Southern California (KPSC) EDs in 2007 and 2008. Death within 7 days of discharge occurred in 357 cases (0.05%). Increasing age, male gender, and number of pre-existing co-morbidities were associated with increased risk of death. The top 3 primary discharge diagnoses predictive of 7-day death after discharge include non-infectious lung disease (OR 7.1, 95% CI 2.9-17.4), renal disease (OR 5.6, 95% CI 2.2-14.2), and ischemic heart disease (OR 3.8, 95%CI 1.0-13.6). Conclusions Our study suggests that 50 in 100,000 patients in the U.S. die within 7-days after discharge from an emergency department. Our study is the first to identify potentially “high risk” discharge diagnoses in patients who suffer a short-term death after discharge.

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Section: Discussionmentioning

confidence: 62%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Patterns and Predictors of Short-Term Death After Emergency Department Discharge

Gabayan

Derose

Asch

et al. 2011

Annals of Emergency Medicine

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“…The inpatient admission did not have to originate from a particular visit such as the ED. A 7‐day time frame was selected based on prior studies of adverse events after ED discharge, local quality improvement efforts that often track 7‐day admissions, and an assumption by the research team that longer time frames were likely to include a larger proportion of events unrelated to the index ED visit. If there were more than one ED visits in the 7 days before an admission, the outcome was attributed to only the most‐recent ED visit.…”

Section: Methodsmentioning

confidence: 99%

Predictors of Admission After Emergency Department Discharge in Older Adults

Gabayan

Sarkisian

Liang

et al. 2014

J American Geriatrics Society

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Objectives To identify predictors of hospital inpatient admission of older Medicare patients following discharge from the emergency department. Design Retrospective cohort study Setting 284 non-federal California hospitals Participants 505,315 visits of patients age >65 years (yrs) with Medicare insurance discharged from California EDs in 2007. Measurement Using the California Office of Statewide Health Planning and Development files, predictors of a hospital inpatient admission within 7 days of ED discharge in older adults (age > 65 yrs) with Medicare were evaluated. Results Hospital inpatient admissions within 7-days of ED discharge occurred in 23,340 (4.6%) visits and were associated with older age (Age 70–74 Adjusted Odds Ration=AOR 1.12, 95% Confidence Interval=CI 1.07–1.17; Age 75–79 AOR 1.18, 95% CI 1.13–1.23; Age 80+ AOR 1.4, 95% CI 1.35–1.46), skilled nursing facility use (AOR 1.82, 95% CI 1.72–1.94), leaving the ED against medical advice (AOR 1.82, 95% CI 1.67–1.98), and the following diagnoses with the highest odds of admission: End Stage Renal Disease (AOR 3.83, 95% CI 2.42–6.08), chronic renal disease (AOR 3.19, 95% CI 2.26–4.49), and congestive heart failure (AOR 3.01, 95% CI 2.59–3.50). Conclusion A total of 4.6% of older adults with Medicare insurance have a hospital inpatient admission after discharge. Chronic conditions such as renal disease and heart failure were associated with the greatest odds of admission.

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“…The follow-up period was divided arbitrarily into 8, 15 and 30 days after discharge from the ED to correspond with data from a previous study 20. The follow-up for deaths was also analysed throughout the whole study period to 31 December 2008.…”

Section: Methodsmentioning

confidence: 99%

Risk of repeat visits, hospitalisation and death after uncompleted and completed visits to the emergency department: a prospective observation study

et al. 2012

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Death within 8 days after discharge to home from the emergency department

Abstract: The mortality rate within 8 days of discharge found in the present study is considerably higher than findings in previous studies. Death shortly after discharge of patients with non-causative diagnosis may indicate a misjudgement of the patients' condition at the time of discharge.

Cited by 20 publications

References 6 publications

Patterns and Predictors of Short-Term Death After Emergency Department Discharge

Patterns and Predictors of Short-Term Death After Emergency Department Discharge

Predictors of Admission After Emergency Department Discharge in Older Adults

Risk of repeat visits, hospitalisation and death after uncompleted and completed visits to the emergency department: a prospective observation study

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