The borderline between the Emergency Department and hospital admission in the hospital mortality analysis

Background. The analysis of hospital mortality rate as a measure of care qu ality is usually restricted to deaths occurred at hospital wards, and no co nsideration is given to deaths occurred at the Emergency Department. Theref ore, the information from a fundamental hospital area goes without analysis . Methods. The following characteristics of deceased individuals at the Emerg ency Department (n = 79) and hospital wards (n = 280) in the Costa del Sol Hospital (Marbella, Malaga, Spain) during 1997 were compared: age, sex, mai n diagnosis at admission, main diagnosis specificity, and number of seconda ry diagnoses. A reevaluation of hospital mortality rates was made after dat a from ED deaths had been added. Results, The addition of deaths occurred at the ED meant a relevant increas e in hospital mortality rates: 57% for heart failure, 30% for stroke, and 2 5% for myocardial infarction. Twenty percent of deaths at the ED had non-sp ecific diagnosis versus 5% at wards (p < 0.0001; 95%CI: 6.03; 24.15). Death s at the ED had 2.9 +/- 1.3 secondary diagnoses versus 4.9 +/- 2.0 in death s at hospital wards (p<0.0001; 95%CI: 1.6; 2.4). Conclusions. Deaths at the ED make up a relevant proportion of the total de aths and should be incorporated to the hospital mortality analysis. Deficie ncies in the collection of clinical information were observed in this ED. T herefore, adjustments for severity -an essential issue for comparing mortal ity rates between centers- might be precluded.