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BMC Emergency Medicine
Published in: BMC Emergency Medicine 1/2019

Open Access 01-12-2019 | Research article

Canadian in-hospital mortality for patients with emergency-sensitive conditions: a retrospective cohort study

Authors: Simon Berthelot, Eddy S. Lang, Hude Quan, Henry T. Stelfox

Published in: BMC Emergency Medicine | Issue 1/2019

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Abstract

Background

The emergency department (ED) sensitive hospital standardized mortality ratio (ED-HSMR) measures risk-adjusted mortality for patients admitted to hospital with conditions for which ED care may improve health outcomes. This study aimed to describe in-hospital mortality across Canadian provinces using the ED-HSMR.

Methods

Hospital discharge data were analyzed from April 2009 to March 2012. The ED-HSMR was calculated as the ratio of observed deaths among patients with emergency-sensitive conditions in a hospital during a year (2010–11 or 2011–12) to the expected deaths for the same patients during the reference year (2009–10), multiplied by 100. The expected deaths were estimated using predictive models fitted from the reference year. Aggregated provincial ED-HSMR values were calculated. A HSMR value above or below 100 respectively means that more or fewer deaths than expected occurred within a province.

Results

During the study period, 1,335,379 patients were admitted to hospital in Canada with an emergency-sensitive condition as the most responsible diagnosis. More in-hospital deaths (95% confidence interval) than expected were respectively observed for the years 2010–11 and 2011–12 in Newfoundland [124.3 (116.3–132.6); & 117.6 (110.1–125.5)] and Nova Scotia [116.4 (110.7–122.5) & 108.7 (103.0–114.5)], while mortality was as expected in Prince Edward Island [99.9 (86.5–114.8) & 100.7 (87.5–115.3)] and Manitoba [99.2 (94.5–104.1) & 98.3 (93.5–103.3)], and less than expected in all other provinces and territories.

Conclusions

Our study revealed important variation in risk-adjusted mortality for patients admitted to hospital with emergency-sensitive conditions among Canadian provinces. The ED-HSMR may be a useful outcome indicator to complement existing process indicators in measuring ED performance.

Trial registration

N/A – Retrospective cohort study.
Appendix
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Metadata
Title
Canadian in-hospital mortality for patients with emergency-sensitive conditions: a retrospective cohort study
Authors
Simon Berthelot
Eddy S. Lang
Hude Quan
Henry T. Stelfox
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Emergency Medicine / Issue 1/2019
Electronic ISSN: 1471-227X
DOI
https://doi.org/10.1186/s12873-019-0270-1

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