Adult mortality rates in emergency departments plummet by 50 percent, Health Affairs study says
ED mortality rates were 1.48 per thousand U.S. adults in 1997. However, by 2011 that number had shrunk to 0.77 per thousand, study showed.
Between 1997 and 2011, there was a nearly 50 percent reduction in emergency department mortality rates for adults in the United States, according to a new study published by Health Affairs.
Analyzing ED visit data from the National Hospital Ambulatory Medical Care Survey, the researchers examined more than 1 billion ED visits and found that those who died tended to be older, were more likely to be male and white, and had more severe triage acuity scores. The proportion of patients visiting a rural ED, or an ED in the South, was higher in patients who died compared to those who survived.
While there wasn't a significant change in inpatient hospital mortality from 2005 to 2011, ED mortality rates were 1.48 per thousand U.S. adults in 1997. However, by 2011 that number had shrunk to 0.77 per thousand.
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For 62.7 percent of the ED visits in which a patient died, patients were noted to be in cardiopulmonary arrest, unconscious or dead on arrival. The most common reason for an ED visit among the remaining patients who died were shortness of breath, which accounted for 8.3 percent of all visits, injury (5.1 percent), and chest pain (3.9 percent).
While noting that more research is needed to determine which are the dominant factors in the ED death rate decline, the study argues that multiple factors are likely working in concert to slash the death rate.
A likely contributor, authors said, is the increased role of palliative care, which results in more patients dying in hospice settings, rather than EDs and acute care settings. Hospice care is gaining prevalence; the study notes that, between 1989 and 2007, there was an increase of more than 50 percent in the proportion of home deaths and a 20 percent decrease in the proportion of hospital deaths.
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Withholding or terminating resuscitation efforts before the patient is transferred to the hospital may also play a role. During the study period, several professional societies published guidelines for prehospital termination of resuscitation, and many cities adopted policies that allowed paramedics to forego resuscitation efforts in certain instances of cardiac arrest. How much this contributes to the ED mortality drop, however, is unclear; financial, legal and societal pressures to transport patients to the hospital have limited the adoption of these policies.
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ED rates have increased substantially for both Medicare and Medicaid beneficiaries, and that, the authors say, could be a more likely factor in the decline. While those populations tend to be sicker and have poorer access to ambulatory care than other adults, they experienced improvements in quality and access outcomes during the study period.
Improvements in emergency medicine and overall public health could likely have played a role, the study said. In recent decades, substantial advances have occurred in the acute management of life-threatening conditions like myocardial infarction, stroke, trauma and sepsis. Those advances include better medical therapies, the regionalization of acute medical and trauma care, and enhanced critical care training of prehospital personnel and emergency physicians.
Another factor may be public health achievements such as smoking cessation and vehicle safety education, the authors said.
Twitter: @JELagasse
