Early mortality in a tertiary care hospital: analysis of quality of care

Objective: To describe and analyze the clinical and epidemiologic characteristics of the care process of patients who died within 24 hours of arriving at emergency department. Methods: Descriptive single-centre study of patients who died in the first 24 hours of arrival at our emergency department in 2009. Results: A total of 164 deaths occurred; 84 patients died after admission to a ward and 83 were in the emergency department (mortality rate, 0.091%). The mean (SD) age of these patients was 78.4 (14.7) years; 54.9% were women and 85% had a significant comorbid condition. The mean Karnofsky index was 66.1 (23.7). The terminal stage of a disease had been reached by 24.7% of the patients, and death was foreseen on the patient's arrival in the emergency department in 82.2%. The most frequent cause of death was cerebrovascular disease (17.3%), followed by pneumonia (16.7%) and septicemia (13.6%). Patients were admitted to an appropriate place in 98.8% of the cases. Treatment with opioid analgesics or sedation was most often provided for patients in a terminal phase (64.1% vs 34.2%, P<.05). Families were informed about the patient's prognosis in 97.1% of the cases; 87% of the patients were accompanied by a relative. Conclusions: Given that the demand for care of patients in terminal phases of disease is growing, analysis of the care process will allow us to ensure that measures are implemented to make them and their families as comfortable as possible. [Emergencias 2011;23:430-436]