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

Parra Caballero P, Curbelo García JJ, Gullón Ojesto A, Ruiz-Giménez Arrieta N, Suárez Fernández C, Del Arco Galán C

Servicio de Medicina Interna. Servicio de Urgencias. Hospital Universitario La Princesa. Madrid, Spain.

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.

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