Non-causative discharge diagnosis from the emergency department and risk of suicide

Suicide Attempts After Emergency Room Visits: The Effect of Patient Safety Goals

In 2007 the Joint Commission National Patient Safety Goals included a requirement addressing risks associated with patient suicidality. The rational for this requirement was that suicide has been the most frequently reported sentinel event since the inception of the Sentinel Event Policy in 1996. The Patient Safety Goals on suicide required hospitals implement actions to assess suicide risk, meet client's immediate safety needs and provide information such as a crisis hotline to individuals and family members for crisis situations. This study performed a secondary data analysis to assess the effect of the 2007 Joint Commission Patient Safety Goals on suicide attempts among patients following treatment at hospital emergency rooms among individuals enrolled in the Florida Medicaid program. A difference-in-difference approach compared changes in rates of suicide attempts for individuals with a primary mental health diagnosis and individuals with a physical health diagnosis after emergency room treatment. In the 6 months following treatment, suicide rates declined after implementation of the goals among patients treated for a primary mental health diagnosis, and increased among patients with a poisoning diagnosis, compared to individuals with a physical health diagnosis. The goals were associated with a reduction in suicide attempts after emergency room treatment.

Survival of patients with alcohol use disorders discharged from an emergency department: a population-based cohort study

OBJECTIVES

The aim was to study the cause-specific mortality of users of the emergency department (ED) who received a diagnosis of alcohol use disorder (AUD) in comparison with mortality of other users of the department.

DESIGN

A population-based prospective cohort study.

PARTICIPANTS

All patients aged 18 years and above who were subsequently discharged home from the ED during the years 2002-2008. A total of 107,237 patients were followed by record linkage to a nationwide cause-of-death registry: 1210 patients with AUD as the main discharge diagnosis and 106,027 patients in the comparison group. HR and 95% CIs were calculated.

SETTING

ED at Landspitali-the National University Hospital of Iceland, Reykjavik, Iceland. The hospital offers tertiary care and is the number one trauma centre and community hospital for the greater Reykjavik area. According to the population registry, 78% of the inhabitants of the area attended the ED during the study period.

RESULTS

72 patients died in the AUD group and 4807 in the comparison group. The adjusted HR for all causes of death was 1.91 (95% CI 1.51 to 2.42). The HR for AUDs was 47.68 (95% CI 11.56 to 196.59) while for alcohol liver disease the HR was 19.06 (95% CI 6.07 to 59.87). The HR was also elevated for diseases of the circulatory system: HR 2.52 (95% CI 1.73 to 3.68); accidental poisoning: HR=13.64, (95% CI 3.98 to 46.73); suicide: HR=2.72 (95% CI 1.08 to 6.83); and event of undetermined intent: HR=10.89 (95% CI 4.53 to 26.16).

CONCLUSIONS

AUD as the discharge diagnosis at the ED, among patients who were not admitted to a hospital ward but discharged home, predicts increased mortality. As the results conclusively show the vulnerability of these patients, one can question whether their needs are adequately met at the ED.

All-cause mortality and suicide within 8 days after emergency department discharge

AIM

The aim of the study was to evaluate the association of death within 8-30 days after discharge home from the emergency department with a non-causative diagnosis in a prospective cohort study.

METHODS

The 227,097 visits to the emergency department were filed by personal identification number and included information on gender, age, admission, discharge, and diagnosis. The visits were classified by main diagnosis at discharge into those with non-causative diagnosis and those with other diagnoses. Mortality per 100,000 within 8, 15 and 30 days and the corresponding hazard ratio (HR) and 95% confidence intervals (CI) were calculated for all causes of death and for selected causes of death in a time-dependent analysis.

RESULTS

The HRs of all causes of death for patients with a non-causative diagnosis were 0.64 (95% CI 0.41-1.01) within 8 days, 0.70 (95% CI 0.50-0.99) within 15 days, and 0.82 (95% CI 0.65-1.04) within 30 days as compared to those with a causative diagnosis. The HRs within 30 days among those with a non-causative diagnosis at discharge were 1.48 (95% CI 1.03-2.13) for malignant neoplasm, 3.72 (95% CI 1.44-9.60) for suicide, and 0.50 (95% CI 0.32-0.79) for diseases of the circulatory system.

CONCLUSION

Death within 8 days after discharge home from the ED is a rare event. Death of patients that occur shortly after discharge who had received a non-causative diagnosis as the main diagnosis may indicate a misjudgement of the patients' condition at that time.