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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.

Author information

1
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. simon.berthelot@crchudequebec.ulaval.ca.
2
Département de médecine familiale et de médecine d'urgence, Université Laval, 1050 avenue de la Médecine, Québec, Québec, G1V 0A6, Canada. simon.berthelot@crchudequebec.ulaval.ca.
3
Department of Emergency Medicine, Foothills Medical Centre, University of Calgary, 1403 29 Street NW, Calgary, Alberta, T2N 2T9, Canada.
4
Department of Community Health Sciences, University of Calgary, TRW Building, 3280 Hospital Drive, Calgary, Alberta, T2N 4Z6, Canada.
5
Department of Critical Care, University of Calgary and Alberta Health Services, McCaig Tower, 1403 29 Street NW, Calgary, Alberta, T2N 2T9, Canada.

Abstract

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

TRIAL REGISTRATION:

N/A - Retrospective cohort study.

KEYWORDS:

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

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