Reviewing deaths in the emergency department: deaths in the department or deaths within 48 h.
OBJECTIVE
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.
Emergency Department, John Hunter Hospital, Newcastle, NSW, Australia.
Sally
S
Clunas
Richard
R
Whitaker
Nicole
N
Ritchie
Jeanette
J
Upton
Geoffrey K
GK
Isbister
D019992:Databases as Topic; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008485:Medical Audit; D019300:Medical Errors; D012189:Retrospective Studies; D013997:Time Factors