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

2019 ◽  
Vol 2019 ◽  
pp. 1-9
Author(s):  
Eric P. Heymann ◽  
Alexandre Wicky ◽  
Pierre-Nicolas Carron ◽  
Aristomenis K. Exadaktylos
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Palliative Care ◽  
Retrospective Analysis ◽  
Clinical Severity ◽  
University Hospital ◽  
Advanced Directives ◽  
Risk Of Death ◽  
Public Data ◽  
Patients At Risk

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.

scholarly journals What impact have Covid-19 pandemic on number of death occurring at the Emergency Department: A Retrospective Analysis of Mortality in India from January 2019 to May 2021

2022 ◽  
Author(s):  
Piyush Kumar
Keyword(s):  
Emergency Department ◽  
Retrospective Analysis ◽  
Urban Health ◽  
Health Facilities ◽  
Data Availability ◽  
Clinical Severity ◽  
Health Management Information System ◽  
Sudden Increase ◽  
Public And Private ◽  
Critical Patients

BackgroundAcute treatment in emergency case management is required for survival and stabilization of critical patients, followed by a shifting to the relevant medical department for further care. However, for the seriously ill critical patients, i.e., when the care provided by the Emergency Department (ED) of the hospital is not enough to enable transfer, death may occur while treatment in the emergency department. This aspect of emergency management is often overlooked, and very few researcher and government is really serious regarding who dies in the ED. Aim and ObjectiveThe aim of my study was to determine the total Mortality occurring in India from 1st January 2019 to 31st May 2021(limitation here due to data availability is limited from accredited source) of emergency department admissions of public and private health facilities. The objective is to find out if there is increase or decrease in mortality of emergency department admissions during the covid-19 pandemic era by comparing average mortality of ED per month of public, private, rural, urban health facilities before the pandemic from 1st and 2nd year of pandemic i.e. 2020 and 2021 respectively MethodsThis research study is a cross sectional retrospective analysis of the mortality occurring at the emergency department of public and private, rural, urban hospitals from 1st January 2019 to May31st 2021 with aim to find out impact of covid-19. Electronic patient records from HMIS (health management information system) of MoHFW (ministry of health and family welfare) , Government of India is collected, observed, analyzed, compared for all patients deaths occurring at Emergency Department (ED) of public and private, rural, urban health facilities (n = 452102) during the period January 2019 to May 2021. ResultsThe study results found that largest total number of death occurred in the ED during may 2021 whereas the least number of deaths occurred in February 2019 (limitation is data availability up to May 2021 from accredited sources). During the first year of the pandemic, average mortality per month (Jan2020-Dec2020) in the emergency department (ED) of rural, urban, public and private hospitals in India was 16067per month whereas before the pandemic it was 12542 per month while during second year of pandemic i.e. 2021 the average mortality increased to 21758 per month (up to May 2021).DiscussionRecently a new strain omicron has again disrupted the normal life and lockdown and other measures are being implemented by different countries to save lives. The mortality at ED are having various etiologies, clinical severity at time of admission has a direct correlation with mortality, which requires the necessity of advanced triage system. There exists a lack of proper knowledge and advanced directives in the beginning i.e. December 2019 of the covid-19 pandemic era.Conclusions Due to novel disease majority of clinicians have challenging situation as well as Emergency Medicine (EM) teams faced a sudden increase in the number of cases with limited resources. Furthermore, a lack of proper knowledge and directives may have hindered access to proper care, as witnessed in many part of the world and available in various literatures. The authors hope that this study will help global researchers as well as policy makers to promote further research and discussion into preparation methods for such pandemics to reduce patient’s risk of death in the ED. KeywordsEmergency department, Death, Covid-19, Pandemic, Health facilities,

A Retrospective Analysis of Patients who Visited the Emergency Department and Left by Their Own Choice in a University Hospital

2013 ◽  
Vol 12 (3) ◽  
pp. 126-129 ◽  
Author(s):  
Mustafa Serinken ◽  
Ibrahim Turkcuer ◽  
Mert Ozen ◽  
Emrah Uyanik ◽  
Hayri Elicabuk ◽  
...  
Keyword(s):  
Emergency Department ◽  
Retrospective Analysis ◽  
University Hospital

Palliative care in the emergency department: A survey assessment of patient and provider perspectives

2020 ◽  
Vol 34 (9) ◽  
pp. 1279-1285
Author(s):  
Emily J Woods ◽  
Alexander D Ginsburg ◽  
Fernanda Bellolio ◽  
Laura E Walker
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Palliative Care ◽  
Response Rate ◽  
Healthcare Providers ◽  
Care Utilization ◽  
Provider Perspectives ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
Emergency Department Patients

Background: Palliative care has been identified as an area of low outpatient referral from our emergency department, yet palliative care has been shown to improve the quality of patient’s lives. Aim: This study investigates both provider and patient perspectives on palliative care for the purpose of identifying barriers to increased palliative care utilization within our healthcare system. Design: Two surveys were developed, one for patients/caregivers and one for healthcare providers. Setting/participants: This was a single-center study completed at a quaternary academic emergency department. A survey was sent to emergency medicine providers with 47% response rate. Research staff approached Emergency Department patients who had been identified to be high risk to fill out paper surveys with 76% response rate. Results: Only 28% of patients had already undergone palliative care, with an additional 25% interested in palliative care. Nearly half of the patients felt that they needed more resources to prevent hospital visits. Patients identified low understanding of palliative care and difficulty accessing appointments as barriers to consultation. Among providers, 98% indicated that they had patients who would benefit from palliative care. A majority of providers highlighted patient understanding of palliative care and access to appointments as barriers to palliative care. Notably, 52% of providers reported that emergency medicine provider knowledge was a barrier to palliative care consultation. Conclusions: Despite emergency department patients’ self-identified need for resources and emergency medicine providers’ recognition of patients who would benefit from palliative care, few patients receive palliative care consultation.

scholarly journals Management of oncology-related emergencies at the emergency department: A long-term undertaking

2020 ◽  
pp. 102490792095367
Author(s):  
Wei Lin Tallie Chua ◽  
Shi En Joanna Chan ◽  
Gillianne Lai ◽  
Looi Yee Tracy Yong ◽  
Ravindran Kanesvaran ◽  
...  
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
Early Warning ◽  
Hospital Setting ◽  
Well Being ◽  
Clinical Severity ◽  
Equal Distribution ◽  
Singapore General Hospital ◽  
Number Of Patients ◽  
Early Warning Scores

Background: The emergency department at the Singapore General Hospital is an emergency department with an annual census of 140,000 and oncology-related attendances of about 4000 (2.8%). These patients are often admitted for further care. Palliative care in the emergency department for these patients is often minimal. The aim of this study was to determine the state of current management of oncology-related emergencies at the Singapore General Hospital’s emergency department, hence identifying specific areas for intervention. Methods: We carried out a retrospective data review of all Singapore General Hospital’s emergency department patients who had either cancer-related diagnoses or were admitted to the Medical Oncology Department in October 2018. Simple statistical analysis was then performed using IBM SPSS version 21. Results: Of 308 identified patients, there was approximately equal distribution by sex. The women were generally younger than the men (61.33 ± 13.63 years vs 67.36 ± 12.02 years, p = 0.063, confidence interval −8.94 to −3.13). Seventy-two (23.4%) of the patients arrived at emergency department by ambulance. The mean emergency department length of stay was 4.25 h. About half of the patients had either lung, colorectal, or breast as their primary site of cancer. There was no correlation between clinical severity according to the National Early Warning Scores and triage complaint-type or emergency clinical diagnosis. More than 90% were admitted, with about 32.6% dying during their inpatient stay. High National Early Warning Scores were significantly associated with mortality. Conclusion: There is large potential for interventions to improve patient well-being in the pre-hospital setting and emergency department. Given the sizable number of patients with poor outcomes, palliative care is also of paramount importance.

Emergency Medicine Physicians' Perspectives of Providing Palliative Care in an Emergency Department

2011 ◽  
Vol 14 (12) ◽  
pp. 1333-1338 ◽  
Author(s):  
Susan C. Stone ◽  
Sarita Mohanty ◽  
Corita R. Grudzen ◽  
Jan Shoenberger ◽  
Steve Asch ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Palliative Care

scholarly journals Treatment With Cardiovascular Medications: Prognosis in Patients With Myocardial Injury

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Erik Kadesjö ◽  
Andreas Roos ◽  
Anwar J. Siddiqui ◽  
Ulrik Sartipy ◽  
Martin J. Holzmann
Keyword(s):  
Myocardial Infarction ◽  
Emergency Department ◽  
Myocardial Injury ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
University Hospital ◽  
Angiotensin Ii Receptor ◽  
Converting Enzyme Inhibitors ◽  
Risk Of Death ◽  
Cardiovascular Medications

Background There is no clinical guidance on treatment in patients with non‐ischemic myocardial injury and type 2 myocardial infarction (T2MI). Methods and Results In a cohort of 22 589 patients in the emergency department at Karolinska University Hospital in Sweden during 2011 to 2014 we identified 3853 patients who were categorized into either type 1 myocardial infarction, T2MI, non‐ischemic acute and chronic myocardial injury. Data from all dispensed prescriptions within 180 days of the visit to the emergency department were obtained concerning β‐blockers, angiotensin‐converting enzyme inhibitors/angiotensin II receptor blockers, statins, and platelet inhibitors. We estimated adjusted hazard ratios (HR) with 95% CI for all‐cause mortality in relationship to the number of medications (categorized into 0–1 [referent], 2–3 and 4 medications) in the groups of myocardial injury. In patients with T2MI, treatment with 2 to 3 and 4 medications was associated with a 50% and 56% lower mortality, respectively (adjusted HR [95% CI], 0.50 [0.25–1.01], and 0.43 [0.19–0.96]), while corresponding associations in patients with acute myocardial injury were 24% and 29%, respectively (adjusted HR [95% CI], 0.76 [0.59–0.99] and 0.71 [0.5–1.02]), and in patients with chronic myocardial injury 27% and 37%, respectively (adjusted HR [95% CI], 0.73 [0.58–0.92] and 0.63 [0.46–0.87]). Conclusions Patients with T2MI and non‐ischemic acute or chronic myocardial injury are infrequently prescribed common cardiovascular medications compared with patients with type 1 myocardial infarction. However, treatment with guideline recommended drugs in patients with T2MI and acute or chronic myocardial injury is associated with a lower risk of death after adjustment for confounders.

scholarly journals Perceived barriers and facilitators to goals of care discussions in the emergency department: A descriptive analysis of the views of emergency medicine physicians and residents

CJEM ◽  
2018 ◽  
Vol 21 (2) ◽  
pp. 211-218 ◽  
Author(s):  
Niran Argintaru ◽  
Kieran L. Quinn ◽  
Lucas B. Chartier ◽  
Jacques Lee ◽  
Paul Hannam ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Palliative Care ◽  
Descriptive Analysis ◽  
Perceived Barriers ◽  
Barriers And Facilitators ◽  
Environmental Interventions ◽  
Goals Of Care ◽  
Care Services ◽  
Palliative Care Services

AbstractObjectiveFew studies have examined the challenges faced by emergency medicine (EM) physicians in conducting goals of care discussions. This study is the first to describe the perceived barriers and facilitators to these discussions as reported by Canadian EM physicians and residents.MethodsA team of EM, palliative care, and internal medicine physicians developed a survey comprising multiple choice, Likert-scale and open-ended questions to explore four domains of goals-of-care discussions: training; communication; environment; and patient beliefs.ResultsSurveys were sent to 273 EM staff and residents in six sites, and 130 (48%) responded. Staff physicians conducted goals-of-care discussions several times per month or more, 74.1% (80/108) of the time versus 35% (8/23) of residents. Most agreed that goals-of-care discussions are within their scope of practice (92%), they felt comfortable having these discussions (96%), and they are adequately trained (73%). However, 66% reported difficulty initiating goals-of-care discussions, and 54% believed that admitting services should conduct them. Main barriers were time (46%), lack of a relationship with the patient (25%), patient expectations (23%), no prior discussions (21%), and the inability to reach substitute decision-makers (17%). Fifty-four percent of respondents indicated that the availability of 24-hour palliative care consults would facilitate discussions in the emergency department (ED).ConclusionsImportant barriers to discussing goals of care in the ED were identified by respondents, including acuity and lack of prior relationship, highlighting the need for system and environmental interventions, including improved availability of palliative care services in the ED.

Emergency medicine in the extreme geriatric era: A retrospective analysis of patients aged in their mid 90s and older in the emergency department

2017 ◽  
Vol 18 (3) ◽  
pp. 415-420 ◽  
Author(s):  
Martin Müller ◽  
Meret E Ricklin ◽  
Stefan Weiler ◽  
Aristomenis K Exadaktylos ◽  
Spyridon Arampatzis
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Retrospective Analysis

scholarly journals Breadth of Emergency Medical Training in Pakistan

2013 ◽  
Vol 28 (2) ◽  
pp. 179-183 ◽  
Author(s):  
Janet Y. Lin ◽  
Saroosh Ahmed ◽  
Caroline Brander
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Medical Care ◽  
Chart Review ◽  
Medical Training ◽  
University Hospital ◽  
Emergency Medical Care ◽  
Emergency Medical ◽  
Medical Education And Training ◽  
Medical Discipline

AbstractIntroductionEmergency medical care in Pakistan has not been a priority of medical education and training because of the country's need to address its lack of primary care. Resources and trained personnel are scarce. Despite these challenges, the value of emergency medical care is gaining attention. The objective of this study was to explore the breadth of Emergency Medicine training in Pakistan through an analysis of an Emergency Medicine residency in a teaching hospital. The Aga Khan University Hospital in Karachi is a teaching institution with the only Emergency Medicine residency program in the region. It was started in 2000, led by US-trained physicians, and it laid the foundation for Emergency Medicine in the country.MethodsThe study was conducted over a four-week period in January of 2009. Data collection consisted of three components: (1) a survey of the Emergency Department and hospital services; (2) a survey of the Emergency Medicine training curriculum; and (3) a retrospective chart review of every tenth patient seen in the Aga Khan Emergency Department from December 1-14, 2008.ResultsThe training program is similar to that of the US models. Of the 153 patients selected for the chart review, the majority presented with GI complaints. Of these, 51 (33%) were admitted to the hospital; 20% (n = 15) left against medical advice; the remaining 57% (n = 87) were discharged.Discussion/ConclusionThe hospital admitted patients with complaints that were expected in the region. Although Aga Khan University Hospital is a pioneer in establishing Emergency Medicine as an official medical discipline in the region, the hospital's obstetrics and gynecology, trauma, toxicology and prehospital services training do not meet current curriculum standards set forth by the Society of Academic Emergency Medicine and the Council of Emergency Medicine Residency Directors. Nevertheless, the review provides a snapshot of the development of Emergency Medical Services in a developing nation. This information may assist other nations that are interested in developing such programs.LinJY, AhmedS, BranderC. Breadth of emergency medical training in Pakistan. Prehosp Disaster Med. 2013;28(2):1-5.

scholarly journals First referral to an integrated onco-palliative care program: A retrospective analysis of its timing.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 167-167
Author(s):  
Claire Barth ◽  
Isabelle Colombet ◽  
Pascale Vinant
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
End Of Life ◽  
Retrospective Analysis ◽  
Hospice Care ◽  
Care Program ◽  
University Hospital ◽  
Cancer Type ◽  
Palliative Care Program ◽  
The Impact

167 Background: Despite being recommended early in the course of advanced cancer, palliative care (PC) referral remains often late. Taking into account limited PC resources, disease-specific referral criteria and models of care need to be explored. In a previous work, we showed that a weekly onco-palliative meeting (OPM) allowed earlier introduction of the PC team (PCT) and decreased aggressiveness of end-of-life (EOL) care1. We describe patient’s profile when first referred to this Integrated Onco-Palliative Care program (IOPC), the timing of the referral relatively to the course of his/her disease and the impact on the trajectory of EOL care. Methods: The IOPC of our University Hospital combined a weekly OPM, dedicated to patients with incurable diseases for whom goals and organization of care need to be discussed, and/or clinical evaluation with possible follow-up by the PCT. We retrospectively analysed all patients reported for the first time at OPM between 2011 and 2013. We calculated an index of precocity, defined as the ratio of time from the first referral to death and the time from the diagnosis of incurability to death, with values ranging from 0 (late referral) to 1 (early referral). Results: Of the 416 patients included, 57% presented with lung cancer, urinary carcinoma and sarcoma. At first referral to IOPC program, 76% were receiving chemotherapy, 63% were outpatients, 56% had a PS ≤ 2 and 46% had a serum albumin level > 35g/l. The median (1st-3rd quartile) index of precocity was 0.39 (0.16-0.72), ranging between 0.53 (0.20-0.79) (earliest, for lung cancer) to 0.16 (0.07-0.56) (latest, for prostate cancer). Among 367 decedents, 42 (13%) received chemotherapy within 14 days before death, 157 (43%) died in hospice care setting. Conclusions: Most patients first referred to IOPC were still under antitumoral treatment and had intermediate prognostic markers. However the time of referral between diagnosis of incurability and death is highly variable according to cancer type, and should probably be adapted while therapies progress.1 Colombet I, et al. Effect of integrated palliative care on the quality of end-of-life care: retrospective analysis of 521 cancer patients. BMJ Support Palliat Care. 2012;2(3):239–47

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