Each year, more than 10,000 generally healthy patients die within seven days after being discharged from a hospital emergency room, according to a recent analysis. Heart disease and chronic obstructive pulmonary disease (COPD) are the most common causes of death among these patients.
A growing number of patients — nearly 20% of the U.S. population — visit the emergency room (ER) every year. As a result, clinicians make the decision to admit or discharge a patient from the department hundreds of thousands of times a day. However, little is known about how patients fare after they are sent home.
The findings are detailed in a study, “Early death after discharge from emergency departments: analysis of national US insurance claims data.”
“There’s a lot of policy interest in reducing unnecessary admissions from the ED [emergency department],” Ziad Obermeyer, MD, a staff physician in the Department of Emergency Medicine at Brigham and Women’s Hospital (BWH) in Boston, said in a press release. “We know that hospitals vary a lot in how often they admit patients to the hospital from the ED, but we don’t know whether this matters for patient outcomes.”
Obermeyer and colleagues at BWH measured how often generally healthy Medicare enrollees died in the seven days after being sent home from an ER, by tracking more than 16 million emergency room visits from 2007–12.
Patients in nursing facilities, or those older that 90 years, receiving palliative or hospice care, or with a diagnosis of a life-limiting illness, were excluded from the analysis.
Among all discharged patients analyzed, the researchers found that each year, 10,093 patients died within seven days after being sent home. The mean age at time of death was 69.
The researchers reported that the leading causes of death on death certificates were atherosclerotic heart disease (13.6%), myocardial infarction (10.3%), and COPD (9.6%). Also, 2.3% died of narcotic overdose, largely after doctor visits for musculoskeletal problems.
These early deaths were more frequent in hospitals that admitted few patients to their emergency rooms, compared to large, university-affiliated hospitals, which admitted more patients, but where early death was less frequent.
Hospitals that admit fewer patients to emergency rooms are often viewed as models by policymakers because of their low costs, in contrast with larger hospitals, which have higher admission rates and higher costs.
Patients discharged from ERs with certain diagnoses, such as altered mental status, dyspnea (shortness of breath), and malaise/fatigue, were more likely to die, compared to those with chest pain, who were at lower risk of early death, the researchers reported.
“The variation in outcomes that we observed may be linked to gaps in medical knowledge about which patients need more attention from physicians, as well as the geographic and socioeconomic context of emergency care. Access to resources varies dramatically across hospitals,” said Obermeyer, who also is an assistant professor of healthcare policy at Harvard Medical School.
“Obviously not all patients can or should be admitted to the hospital. But we need to focus on admitting the right patients, rather than admitting more or less. I’m optimistic that advanced analytics and better data will help physicians with these kinds of decisions in the future,” Obermeyer concluded.