The incidence of death within 7 days of discharge from emergency departments is high among Medicare beneficiaries, despite no obvious life-limiting illnesses recorded in their claims, according to a study published in the BMJ.
Ziad Obermeyer, MD, MPhil, from the Department of Emergency Medicine at Harvard Medical School in Boston, and colleagues, identified claims data from the US Medicare program, covering visits to an emergency department from 2007 to 2012. Generally healthy patients were included in the study. Patients were excluded if they were aged >90, received palliative or hospice care, or if they received a diagnosis of a life-limiting illness, either during emergency department visits (such as myocardial infarction) or in the year before (such as malignancy.)
The primary outcome was death within 7 days after discharge from emergency departments, excluding patients transferred or admitted as inpatients. Seven-day mortality was chosen on the assumption that discharged patients were deemed to be at low risk of acute deterioration, such that no immediate testing or treatment was required, and they would be able to return to care if their condition worsened.
Among 10,093,678 discharged patients, 0.12% (12,375) died within 7 days, or 10,093 per year nationally. Average age at death was 69; 50.3% were men, and 80.9% were white. Death certificates identified atherosclerotic heart disease (13.6%), acute myocardial infarction (10.3%), and chronic obstructive pulmonary disease (9.6%) as the most common causes of death. Approximately 2.3% died of a narcotic overdose.
Hospitals in the lowest fifth of rates of inpatient admission from the emergency department had the highest rates of early death (0.27%), which was 3.4 times higher than hospitals in the highest fifth (0.08%), despite the fact that hospitals with low admission rates served healthier populations. Emergency departments that had higher volumes of patients (odds ratio [OR], 0.84) and those with higher charges for visits (OR, 0.75) had significantly fewer deaths. Certain diagnoses were more common among early deaths, compared with other emergency department visits, such as altered mental status (risk ratio [RR], 4.4), dyspnea (RR, 3.1), and malaise/fatigue (RR, 3.0).
“We found that over 10,000 Medicare beneficiaries each year died within 7 days after being discharged from emergency departments, despite mean age of 69 and no obvious life-limiting illnesses,” said the authors. “Hospitals with low admission rates and low patient volumes, and patients with high risk diagnoses at discharge, could represent targets for clinical research and quality improvement efforts.”
- Obermeyer Z, Cohn B, Wilson M, et al. Early death after discharge from emergency departments: analysis of national US insurance claims data. BMJ. 1 February 2017. doi: 10.1136/bmj.j239