ER death rate drops by half over 15-year period

Emergency department

Emergency department deaths dropped by nearly 50 percent between 1997 and 2011, according to a study published in Health Affairs, and the research team points to advances in palliative care, prehospital and emergency care as factors for the decline.

Researchers analyzed emergency room visit data from the National Hospital Ambulatory Medical Care Survey, including all ED visits by adults over the 15-year study period. The data was divided further by race, age, sex, insurance status, geographic location and other factors, according to the study. The team studied more than 365,000 observations, representing more than 1.3 billion ED visits in the United States.

Over the course of the study’s 15-year data period, deaths in the ER decreased by 48 percent. In comparison, there was no significant change in inpatient hospital mortality between 2005 and 2011, according to the study.

In 62 percent of the visits involving patient deaths, the patients were in cardiac arrest, unconscious or dead upon arrival, according to the study. More than 8 percent of patients who died in the ED reported shortness of breath as their primary symptom, and more than 5 percent of those who died came to the ER to treat an injury.

The study team writes that further studies will be needed to pinpoint exactly why deaths in the ED have dropped so significantly, but they listed to several possible explanations for the decrease, including:

  • Patients are surviving in the ED, but die after being admitted to the hospital. The team points to the lack of a notable decrease in inpatient deaths as evidence of this possible trend. 
  • Palliative care is gaining an increasing role in medicine, including the ED. Because of this, patients are more likely to die in a hospice center or under hospice care at home, the team writes. They noted that between 1989 and 2007, the number of home deaths increased by more than 50 percent, leading to a reduction in hospital deaths by more than 20 percent. 
  • “Do Not Resuscitate” orders may terminate care before patients reach the hospital. The team suggested that this may be especially true of cardiac arrest patients, who are now more likely to be declared dead before reaching the hospital than at the ED. 
  • Substantial strides have been made in treating life-threatening conditions like stroke, trauma and sepsis, including more effective therapies and enhanced training in critical care.

The research team included Hemal Kanzaria, M.D., assistant professor of clinical emergency medicine at University of California San Francisco (UCSF); Marc Probst, assistant professor of emergency medicine at the Icahn School of Medicine at Mount Sinai in New York; and Renee Hsia, M.D., professor of emergency medicine at UCSF.

- here’s the study abstract