Reviewing deaths in the emergency department

Deaths in the department or deaths within 48?h

S CLUNAS, R WHITAKER, N RITCHIE, J UPTON, Geoffrey Isbister

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objectives: To investigate an ED death audit process that included deaths occurring within 48 h of admission in addition to deaths in the ED. Methods: The study was a review of a prospective audit process undertaken in routine clinical practice that included auditing deaths in the ED and deaths of admitted patients within 48 h of ED presentation. Data were extracted from the audit database and included demography, clinical information and medical recommendations. The hospital incident investigation and monitoring system (IIMS) was searched for major incident reports involving death. The main outcome was the number of medical record audits from each group reported to the clinical governance unit for review, and whether the 48 h audit identified relevant cases to the ED in addition to those identified in the ED audit alone. Secondary outcomes were the number of audits resulting in other actions: ED policy review, education, case discussion or review with the inpatient team. Results: Over a 2 year period, 303 deaths were reviewed, including 75 deaths in the ED and 228 deaths within 48 h. The ED auditor recommended no further action in 66/75 (88%) ED deaths and 195/228 (86%) 48 h deaths. A major hospital review was recommended in 4/75 (5%) ED deaths and 11/228 (5%) 48 h deaths, with only 3 and 7 of these, respectively, having been detected by the hospital's IIMS. The audit identified 10 of 13 deaths notified to the IIMS and the remaining 3 did not involve error relevant to the ED. Internal review was recommended in one ED death and eight 48 h deaths. Conclusions: The present study demonstrates that auditing both ED deaths and 48 h deaths identifies additional issues relevant to the ED compared with auditing ED deaths alone or relying on standard hospital incident reporting. � 2009 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.
Original languageEnglish
Pages (from-to)117-123
Number of pages7
JournalEMA - Emergency Medicine Australasia
Volume21
Issue number2
Publication statusPublished - 2009

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Hospital Emergency Service
Emergency Medicine
Medical Audit
Clinical Governance
Risk Management
Medical Records
Inpatients

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CLUNAS, S., WHITAKER, R., RITCHIE, N., UPTON, J., & Isbister, G. (2009). Reviewing deaths in the emergency department: Deaths in the department or deaths within 48?h. EMA - Emergency Medicine Australasia, 21(2), 117-123.
CLUNAS, S ; WHITAKER, R ; RITCHIE, N ; UPTON, J ; Isbister, Geoffrey. / Reviewing deaths in the emergency department : Deaths in the department or deaths within 48?h. In: EMA - Emergency Medicine Australasia. 2009 ; Vol. 21, No. 2. pp. 117-123.
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abstract = "Objectives: To investigate an ED death audit process that included deaths occurring within 48 h of admission in addition to deaths in the ED. Methods: The study was a review of a prospective audit process undertaken in routine clinical practice that included auditing deaths in the ED and deaths of admitted patients within 48 h of ED presentation. Data were extracted from the audit database and included demography, clinical information and medical recommendations. The hospital incident investigation and monitoring system (IIMS) was searched for major incident reports involving death. The main outcome was the number of medical record audits from each group reported to the clinical governance unit for review, and whether the 48 h audit identified relevant cases to the ED in addition to those identified in the ED audit alone. Secondary outcomes were the number of audits resulting in other actions: ED policy review, education, case discussion or review with the inpatient team. Results: Over a 2 year period, 303 deaths were reviewed, including 75 deaths in the ED and 228 deaths within 48 h. The ED auditor recommended no further action in 66/75 (88{\%}) ED deaths and 195/228 (86{\%}) 48 h deaths. A major hospital review was recommended in 4/75 (5{\%}) ED deaths and 11/228 (5{\%}) 48 h deaths, with only 3 and 7 of these, respectively, having been detected by the hospital's IIMS. The audit identified 10 of 13 deaths notified to the IIMS and the remaining 3 did not involve error relevant to the ED. Internal review was recommended in one ED death and eight 48 h deaths. Conclusions: The present study demonstrates that auditing both ED deaths and 48 h deaths identifies additional issues relevant to the ED compared with auditing ED deaths alone or relying on standard hospital incident reporting. � 2009 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.",
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CLUNAS, S, WHITAKER, R, RITCHIE, N, UPTON, J & Isbister, G 2009, 'Reviewing deaths in the emergency department: Deaths in the department or deaths within 48?h', EMA - Emergency Medicine Australasia, vol. 21, no. 2, pp. 117-123.

Reviewing deaths in the emergency department : Deaths in the department or deaths within 48?h. / CLUNAS, S; WHITAKER, R; RITCHIE, N; UPTON, J; Isbister, Geoffrey.

In: EMA - Emergency Medicine Australasia, Vol. 21, No. 2, 2009, p. 117-123.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Reviewing deaths in the emergency department

T2 - Deaths in the department or deaths within 48?h

AU - CLUNAS, S

AU - WHITAKER, R

AU - RITCHIE, N

AU - UPTON, J

AU - Isbister, Geoffrey

PY - 2009

Y1 - 2009

N2 - Objectives: To investigate an ED death audit process that included deaths occurring within 48 h of admission in addition to deaths in the ED. Methods: The study was a review of a prospective audit process undertaken in routine clinical practice that included auditing deaths in the ED and deaths of admitted patients within 48 h of ED presentation. Data were extracted from the audit database and included demography, clinical information and medical recommendations. The hospital incident investigation and monitoring system (IIMS) was searched for major incident reports involving death. The main outcome was the number of medical record audits from each group reported to the clinical governance unit for review, and whether the 48 h audit identified relevant cases to the ED in addition to those identified in the ED audit alone. Secondary outcomes were the number of audits resulting in other actions: ED policy review, education, case discussion or review with the inpatient team. Results: Over a 2 year period, 303 deaths were reviewed, including 75 deaths in the ED and 228 deaths within 48 h. The ED auditor recommended no further action in 66/75 (88%) ED deaths and 195/228 (86%) 48 h deaths. A major hospital review was recommended in 4/75 (5%) ED deaths and 11/228 (5%) 48 h deaths, with only 3 and 7 of these, respectively, having been detected by the hospital's IIMS. The audit identified 10 of 13 deaths notified to the IIMS and the remaining 3 did not involve error relevant to the ED. Internal review was recommended in one ED death and eight 48 h deaths. Conclusions: The present study demonstrates that auditing both ED deaths and 48 h deaths identifies additional issues relevant to the ED compared with auditing ED deaths alone or relying on standard hospital incident reporting. � 2009 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

AB - Objectives: To investigate an ED death audit process that included deaths occurring within 48 h of admission in addition to deaths in the ED. Methods: The study was a review of a prospective audit process undertaken in routine clinical practice that included auditing deaths in the ED and deaths of admitted patients within 48 h of ED presentation. Data were extracted from the audit database and included demography, clinical information and medical recommendations. The hospital incident investigation and monitoring system (IIMS) was searched for major incident reports involving death. The main outcome was the number of medical record audits from each group reported to the clinical governance unit for review, and whether the 48 h audit identified relevant cases to the ED in addition to those identified in the ED audit alone. Secondary outcomes were the number of audits resulting in other actions: ED policy review, education, case discussion or review with the inpatient team. Results: Over a 2 year period, 303 deaths were reviewed, including 75 deaths in the ED and 228 deaths within 48 h. The ED auditor recommended no further action in 66/75 (88%) ED deaths and 195/228 (86%) 48 h deaths. A major hospital review was recommended in 4/75 (5%) ED deaths and 11/228 (5%) 48 h deaths, with only 3 and 7 of these, respectively, having been detected by the hospital's IIMS. The audit identified 10 of 13 deaths notified to the IIMS and the remaining 3 did not involve error relevant to the ED. Internal review was recommended in one ED death and eight 48 h deaths. Conclusions: The present study demonstrates that auditing both ED deaths and 48 h deaths identifies additional issues relevant to the ED compared with auditing ED deaths alone or relying on standard hospital incident reporting. � 2009 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

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KW - clinical practice

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JO - Emergency Medicine Australasia

JF - Emergency Medicine Australasia

SN - 1742-6723

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