More than half of 129 patients who died unexpectedly after they were discharged from EDs exhibited abnormal vital signs at the time.1 Each patient had presented to an urban academic ED between 2014 and 2017, and died within seven days after they went home.
“The findings should perk up the ears of ED providers and remind them to take a second look at if discharge is safe, or if rapid follow-up or admission should be considered,” says Richard Hoang, MD, the study’s lead author and an EP and trauma team leader at Sunnybrook Health Sciences Centre in Toronto.
Pneumonia was the most common cause of death. Recurrent themes among the patients included multiple complaints or comorbidities, acute progression of chronic disease, and a history of recurrent falls.
Other common factors included patients with multiple ED visits, patients who had been admitted recently, or patients for whom no repeat vital signs were recorded. ED providers failed to admit high-risk elderly patients, missed diagnoses, and failed to consider infectious etiology.
“Hopefully, this encourages clinicians to consider repeating vital signs prior to discharg[ing] their patients,” Hoang says.
REFERENCE
- Hoang R, Sampsel K, Willmore A, et al. Remember that patient you saw last week: Characteristics and frequency of patients experiencing anticipated and unanticipated death following ED discharge. CJEM 2021;23:767-771.
Repeating vital signs before discharge is key to averting disaster.
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