Introduction
Materials and methods
Study design and settings
Primary endpoint
Secondary endpoint
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ED arrival
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Nurse triage
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Medical history/physical examination
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Appropriate diagnostic tests
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Timing of test ordering
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Interpretation of test results
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Appropriate treatment
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Timing of treatment ordered/given
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Wait/monitoring
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ED disposition
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Handover
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Medical ward
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Operation room
Selection of participants
Analysis
Results
All patients
|
Unexpected deaths
| |||
---|---|---|---|---|
Characteristic
| ||||
N | 484 | 47 | ||
Age (years), mean (SD)
| 79 | (14) | 79 | (14) |
Sex male, N (%)
| 247 | (51%) | 32 | (68%) |
Center
| ||||
Pitié-Salpêtrière | 231 | (47%) | 25 | 25 |
Bichat | 90 | (19%) | 13 | (14%) |
Ambroise Paré | 88 | (18%) | 4 | (5%) |
Saint Antoine | 75 | (15%) | 5 | (7%) |
Type of arrival
| ||||
own | 23 | (5%) | 7 | (15%) |
ambulances | 376 | (78%) | 37 | (77%) |
medical EMS | 85 | (18%) | 3 | (6%) |
Vital parameters
| ||||
systolic BP (mmHg), mean (SD) | 122 | (36) | 119 | (29) |
diastolic BP (mmHg), mean (SD) | 69 | (22) | 70 | (22) |
heart rate, mean (SD) | 93 | (27) | 92 | (26) |
Glasgow Coma Scale, median [IQR] | 15 | [9-15] | 15 | [15] |
temperature (°C), mean (SD) | 36.5 | (1.4) | 36.8 | (1.0 |
Limitation of care
| 70 | (14%) | 0 | (0%) |
Preventability of death
| ||||
very unlikely | 10 | (21%) | ||
unlikely | 13 | (27%) | ||
likely | 15 | (32%) | ||
very likely | 9 | (32%) |
Patient
|
Age
|
Main medical errors
|
Provider
|
ED diagnosis
|
Cause of death
|
---|---|---|---|---|---|
1 | 87 | Denial of ICU admission | ICU physician | Sigmoid volvulus | Sigmoid volvulus |
2 | 79 | wrong dose of opioids analgesic | Orthopedist surgeon | Urinary retention | Opioid intoxication |
3 | 81 | No timely treatment of acute coronary syndrome | Emergency physician | Myocardial infarction | Myocardial infarction |
4 | 79 | Pacemaker has not been monitored after a syncope | Emergency physician | Syncope | Cardiac arrest |
5 | 83 | No fluid resuscitation no antibiotics | Emergency physician | Fatigue | Severe sepsis |
6 | 80 | No treatment of congestive heart failure and no blood transfusion | Emergency physician and orthopedic surgeon | Hip fracture | Congestive heart failure |
7 | 87 | No control of hyperkaliemia | Emergency physician | Metabolic acidosis | Cardiac arrest |
8 | 83 | Undertriage on arrival | Triage nurse | Intracranial hemorrhage | Intracranial hemorrhage |
9 | 43 | No chest X-ray before chest drainage | Emergency physician | Respiratory failure | Hemothorax |
10 | 77 | No fluid resuscitation and wrong antibiotic administration | Emergency physician | Severe sepsis | Severe sepsis |
11 | 53 | No fluid resuscitation and delay in antibiotic administration | Emergency physician | Urinary tract infection | Severe sepsis |
12 | 63 | No reheating | Emergency physician | Hypothermia | Hypothermia |
13 | 71 | No head CT performed | Emergency physician | Seizure | Intracranial hemorrhage |
14 | 85 | No fluid resuscitation no antibiotics | Emergency physician | Severe sepsis | Severe sepsis |
15 | 61 | Delay in performing ECG and treatment of acute coronary syndrome | Emergency physician | Acute coronary syndrome | Acute coronary syndrome |
16 | 74 | No monitoring and no correction of hypokaliemia | Emergency physician | Ketoacidosis | Hypokaliemia |
17 | 70 | No fluid resuscitation | Emergency physician | Pneumoniae | Severe sepsis |
18 | 54 | No fluid resuscitation | Emergency physician | Sepsis | Severe sepsis |
19 | 85 | No diagnosis and treatment of acute heart failure | Orthopedist surgeon | Hip fracture | Heart failure |
20 | 63 | Insufficient fluid resuscitation and denial of ICU admission | Emergency physician and ICU physician | Upper GI bleed | Upper GI bleed |
21 | 87 | No fluid resuscitation no antibiotics | Emergency physician | Arthritis | Severe sepsis |
22 | 77 | No fluid resuscitation no antibiotics | Emergency physician | COPD exacerbation | Severe sepsis |
23 | 78 | No fluid resuscitation and delay in antibiotic administration | Emergency physician | Severe sepsis | Severe sepsis |
24 | 57 | Undertriage on arrival and denial of ICU admission | Emergency physician and triage nurse | Heart failure | Heart failure |
Discussion
Limitations
Conclusions
Key message
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Prevalence of medical errors among admitted patients who had early unanticipated death after ED visit is unknown.
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In our study, we found that the rate of unanticipated death within 72 hours of ED visit is 85 per 100,000 admissions.
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Half of these deaths were expertised as caused by medical errors
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The most common cause of medical error was a severe delay or the absence of detection and recommended treatment for severe sepsis.