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Unavoidable deaths in the Italian Emergency Departments. Results of a ten-year survey. A mirror of substantial social changes, or a warning for a hospital-system pathology?

Gianfranco Cervellin, Ivo Casagranda, Giorgio Ricci, Ilenia Mezzocolli, Ciro Paolillo, Rita Rossi, Andrea Bellone, Stefano Guzzetti, Fabrizio Giostra, Gianni Rastelli, Mario Cavazza
  • Gianfranco Cervellin
    Emergency Department, University Hospital of Parma, Parma, Italy | gcervellin@ao.pr.it
  • Ivo Casagranda
    Emergency Department, S.S. Antonio e Biagio e C. Arrigo Hospital, Alessandria, Italy
  • Giorgio Ricci
    Emergency Department, University Hospital Borgo Trento, Verona, Italy
  • Ilenia Mezzocolli
    Emergency Department, University Hospital of Padua, Padua, Italy
  • Ciro Paolillo
    Emergency Department, University Hospital of Udine, Udine, Italy
  • Rita Rossi
    Emergency Department, Hospitals of the Province of Teramo, Teramo, Italy
  • Andrea Bellone
    Emergency Department, Niguarda Hospital, Milan, Italy
  • Stefano Guzzetti
    Emergency Department, Luigi Sacco Hospital, Milan, Italy
  • Fabrizio Giostra
    Emergency Department, Murri Hospital, Fermo, Italy
  • Gianni Rastelli
    Emergency Department, Vaio Hospital, Fidenza (PC), Italy
  • Mario Cavazza
    Emergency Department, S. Orsola Malpighi University Hospital, Bologna, Italy

Abstract

Emergency departments (EDs) are increasingly used for patients at the end of life stage of their diseases worldwide, even if they do not have acute and potentially treatable conditions. Moreover, an increasingly shortage of hospital beds, in spite of the well-recognized ageing of the population, has led to a progressive prolongation of the average length of stay (LOS) time in the vast majority of Italians EDs. Therefore, the aim of this study was to describe the trend of ED non-traumatic deaths in 11 Italians EDs, and to correlate these deaths with the medium length of stay in the same EDs. All cases classified as died during ambulance transfer or while in the ED have been retrieved from the hospital database of the 11 participating EDs, from January 1st 2007 to December 31st 2016, with the exclusion of traumatic events. The average LOS in minutes of the seven hospitals that could provide this information was then calculated. A continuously increasing number of ED deaths was observed in the vast majority of participating EDs, showing a nearly 30% increases in the last four years. The average LOS of the vast majority of participating hospitals displayed a significant increase during the observational period. We also found a linear correlation between average LOS and total number of ED deaths in the same seven hospitals. We believe that there is a compelling need to reconsider the end of life trajectories, not only under an economical perspective, but mainly according to a more ethical view.

Keywords

Death; Emergency department; Palliative care; End of life; Length of stay

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Submitted: 2017-03-20 15:20:40
Published: 2017-04-28 11:07:07
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Copyright (c) 2017 Gianfranco Cervellin

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