Unanticipated death after discharge home from the emergency department
Unanticipated death after discharge home from the emergency department
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DOI：
10.1016/j.annemergmed.2006.11.018
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发表时间：
2007-06-01
影响因子：
6.2
通讯作者：
Helitzer, Deborah L.
中科院分区：
文献类型：
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作者：
Sklar, David P.;Crandall, Cameron S.;Helitzer, Deborah L.
研究目的：我们测量了从急诊科 (ED) 出院的患者意外死亡的频率，并审查了这些病例中潜在的可预防医疗过失的模式。方法：这是一组在评估后从城市三级医疗机构出院回家的 ED 患者的回顾性队列，并进行了随后的病例审查。受试者年龄为 10 岁及以上，代表 1994 年 2 月至 2004 年 11 月期间 186,859 人中的 387,334 次就诊。主要结果是死亡率。评估死亡与上次急诊就诊的相关性、死亡是否是预期的以及是否可能存在医疗错误。使用扎根理论对与急诊就诊相关的意外死亡进行了分析，以确定这些病例中的共同主题。错误病例被确定为该组的一个子集。结果：我们识别并审查了 117 名患者，即每 100,000 名急诊出院回家者中，出院 7 天内有 30.2 例死亡（95% 置信区间 [Cl] 25.2 至 36.2 例死亡）。在 117 例中，58 例 (50%) 是意外的，但与急诊室就诊有关，其中 35 例 (60%) 可能存在错误。对于意外的相关组，每 100,000 名出院回家者中有 15.0 人在 7 天内死亡（95% Cl 11.6 至 19.4 死亡）；对于可能的错误组，有 9.0 例（95% Cl 6.5 至 12.6 死亡）。四个主题反复出现：异常问题的非典型表现、失代偿的慢性疾病、生命体征异常、精神残疾或精神问题或药物滥用，这些可能会降低患者因症状恶化而返回的可能性。结论：监测死亡记录可以识别就医后的意外死亡。需要进一步的假设驱动研究来识别、预防或减轻护理问题并降低急诊就诊后的死亡率。
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 [Cl] 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% Cl 11.6 to 19.4 deaths); for the possible error group, there were 9.0 (95% Cl 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.