title: Unexpected death within 72 hours of emergency department visit: were those deaths preventable?
abstract: BACKGROUND
  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.
authors.affiliation: 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.|Public Health Department, Hôpital Ambroise Paré, APHP, 9 avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France. helene.goulet@psl.aphp.fr.
authors.forename: Hélène
authors.initials: H
authors.lastname: Goulet
authors.affiliation: Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique- Hôpitaux de Paris (APHP), 47-83 Boulevard de l'Hôpital, 75013, Paris, France. guerandvictor@gmail.com.
authors.forename: Victor
authors.initials: V
authors.lastname: Guerand
authors.affiliation: Emergency Department, Royal London Hospital, Whitechapel Road, London, E1 1BB, UK. ben.bloom@nhs.net.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Bloom
authors.affiliation: Public Health Department, Hôpital Ambroise Paré, APHP, 9 avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France. patricia.martel@apr.aphp.fr.
authors.forename: Patricia
authors.initials: P
authors.lastname: Martel
authors.affiliation: Public Health Department, Hôpital Ambroise Paré, APHP, 9 avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France. philippe.aegerter@apr.aphp.fr.|Université Versailles Saint-Quentin, Saint-Quentin en Yvelines, 55 avenue de Paris, Versailles, 78000, France. philippe.aegerter@apr.aphp.fr.
authors.forename: Philippe
authors.initials: P
authors.lastname: Aegerter
authors.affiliation: 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.
authors.forename: Enrique
authors.initials: E
authors.lastname: Casalino
authors.affiliation: 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.|Sorbonne Université, UPMC univ-Paris 6, UMRS INSERM 1166, IHU ICAN, 91 Boulevard de l'Hôpital, 75013, Paris, France. bruno.riou@psl.aphp.fr.
authors.forename: Bruno
authors.initials: B
authors.lastname: Riou
authors.affiliation: Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique- Hôpitaux de Paris (APHP), 47-83 Boulevard de l'Hôpital, 75013, Paris, France. yonatman@gmail.com.|Sorbonne Université, UPMC univ-Paris 6, UMRS INSERM 1166, IHU ICAN, 91 Boulevard de l'Hôpital, 75013, Paris, France. yonatman@gmail.com.
authors.forename: Yonathan
authors.initials: Y
authors.lastname: Freund
mesh_terms: D000368:Aged; D054869:Clinical Audit; D004636:Emergency Service, Hospital; D005260:Female; D005602:France; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000706:statistics & numerical data*; D010343:Patient Admission; D011787:Quality of Health Care; D012189:Retrospective Studies; D018805:Sepsis / Q000401:mortality; D061665:Time-to-Treatment