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BMC Emerg Med. 2019 Oct 22;19(1):57. doi: 10.1186/s12873-019-0270-1.

Canadian in-hospital mortality for patients with emergency-sensitive conditions: a retrospective cohort study.

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Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, 2705 Boul. Laurier, Québec, G1V 4G2, Canada.
Département de médecine familiale et de médecine d'urgence, Université Laval, 1050 avenue de la Médecine, Québec, Québec, G1V 0A6, Canada.
Department of Emergency Medicine, Foothills Medical Centre, University of Calgary, 1403 29 Street NW, Calgary, Alberta, T2N 2T9, Canada.
Department of Community Health Sciences, University of Calgary, TRW Building, 3280 Hospital Drive, Calgary, Alberta, T2N 4Z6, Canada.
Department of Critical Care, University of Calgary and Alberta Health Services, McCaig Tower, 1403 29 Street NW, Calgary, Alberta, T2N 2T9, Canada.



The emergency department (ED) sensitive hospital standardized mortality ratio (ED-HSMR) measures risk-adjusted mortality for patients admitted to hospital with conditions for which ED care may improve health outcomes. This study aimed to describe in-hospital mortality across Canadian provinces using the ED-HSMR.


Hospital discharge data were analyzed from April 2009 to March 2012. The ED-HSMR was calculated as the ratio of observed deaths among patients with emergency-sensitive conditions in a hospital during a year (2010-11 or 2011-12) to the expected deaths for the same patients during the reference year (2009-10), multiplied by 100. The expected deaths were estimated using predictive models fitted from the reference year. Aggregated provincial ED-HSMR values were calculated. A HSMR value above or below 100 respectively means that more or fewer deaths than expected occurred within a province.


During the study period, 1,335,379 patients were admitted to hospital in Canada with an emergency-sensitive condition as the most responsible diagnosis. More in-hospital deaths (95% confidence interval) than expected were respectively observed for the years 2010-11 and 2011-12 in Newfoundland [124.3 (116.3-132.6); & 117.6 (110.1-125.5)] and Nova Scotia [116.4 (110.7-122.5) & 108.7 (103.0-114.5)], while mortality was as expected in Prince Edward Island [99.9 (86.5-114.8) & 100.7 (87.5-115.3)] and Manitoba [99.2 (94.5-104.1) & 98.3 (93.5-103.3)], and less than expected in all other provinces and territories.


Our study revealed important variation in risk-adjusted mortality for patients admitted to hospital with emergency-sensitive conditions among Canadian provinces. The ED-HSMR may be a useful outcome indicator to complement existing process indicators in measuring ED performance.


N/A - Retrospective cohort study.


Emergency department; Emergency sensitive conditions; Mortality; Standardized mortality ratio

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