Format

Send to

Choose Destination
Crit Care. 2015 Apr 8;19:154. doi: 10.1186/s13054-015-0877-x.

Unexpected death within 72 hours of emergency department visit: were those deaths preventable?

Author information

1
Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique- Hôpitaux de Paris (APHP), 47-83 Boulevard de l'Hôpital, 75013, Paris, France. helene.goulet@psl.aphp.fr.
2
Public Health Department, Hôpital Ambroise Paré, APHP, 9 avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France. helene.goulet@psl.aphp.fr.
3
Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique- Hôpitaux de Paris (APHP), 47-83 Boulevard de l'Hôpital, 75013, Paris, France. guerandvictor@gmail.com.
4
Emergency Department, Royal London Hospital, Whitechapel Road, London, E1 1BB, UK. ben.bloom@nhs.net.
5
Public Health Department, Hôpital Ambroise Paré, APHP, 9 avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France. patricia.martel@apr.aphp.fr.
6
Public Health Department, Hôpital Ambroise Paré, APHP, 9 avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France. philippe.aegerter@apr.aphp.fr.
7
Université Versailles Saint-Quentin, Saint-Quentin en Yvelines, 55 avenue de Paris, Versailles, 78000, France. philippe.aegerter@apr.aphp.fr.
8
Emergency Department, Hôpital Bichat, APHP, EA 7334 REMES, Université Paris Diderot, Sorbonne Paris Cité, 46 rue Henri Huchard, 75877, Paris, France. enrique.casalino@bch.aphp.fr.
9
Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique- Hôpitaux de Paris (APHP), 47-83 Boulevard de l'Hôpital, 75013, Paris, France. bruno.riou@psl.aphp.fr.
10
Sorbonne Université, UPMC univ-Paris 6, UMRS INSERM 1166, IHU ICAN, 91 Boulevard de l'Hôpital, 75013, Paris, France. bruno.riou@psl.aphp.fr.
11
Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique- Hôpitaux de Paris (APHP), 47-83 Boulevard de l'Hôpital, 75013, Paris, France. yonatman@gmail.com.
12
Sorbonne Université, UPMC univ-Paris 6, UMRS INSERM 1166, IHU ICAN, 91 Boulevard de l'Hôpital, 75013, Paris, France. yonatman@gmail.com.

Abstract

INTRODUCTION:

We aimed to determine the rate of preventable death in patients who died early and unexpectedly following hospital admission from the emergency department (ED).

METHODS:

We conducted a retrospective multicenter study in four centers from the Paris metropolitan area. Inclusion criteria were medical patients who died in hospital within 72 hours of ED attendance and were not admitted to the intensive care unit (unexpected death). Exclusion criteria were limitations of care determined by treating physicians. The existence of a limitation of care decision was adjudicated by two independent chart abstractors. Preventable death was defined as death occurring as a result of medical error. For each selected patient with unexpected death, charts were examined for medical errors and rated on a 1 to 5 preventability scale (from very unlikely to very likely) for the preventability of the death. The primary endpoint was the likely preventable death, rated as 4 or 5 on the preventability scale.

RESULTS:

We retrieved 555 charts; 47 unexpected deaths were analysed; 24 (51%) were considered as preventable. There was a median number of medical errors of two. The most common process breakdowns were incorrect choice of treatment (47% of patients) and failure to order appropriate diagnostic tests (38% of patients). The most common medical error was a severe delay or absence of recommended treatment for severe sepsis, which occurred in 10 (42%) patients.

CONCLUSIONS:

In our sample, more than half of unexpected deaths are related to a medical error, and could have been prevented.

PMID:
25887707
PMCID:
PMC4403754
DOI:
10.1186/s13054-015-0877-x
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for BioMed Central Icon for PubMed Central
Loading ...
Support Center