Mortality rates in the ER nosedive over past 15 years

Between 1997 and 2011, the number of deaths in emergency departments (ED) has been cut nearly in half, down from 1.48 deaths per thousand to 0.77 per thousand.  Researchers published the study in Health Affairs after shifting through data on 1.3 billion ED visits. While saying they weren’t able to pinpoint an exact cause for the drop in mortality, the researchers cite advancements in pre-hospital, palliative, and emergency care as possible factors. Some of the factors they mention in the study include:

•    “Do Not Resuscitate” orders may terminate care before patients reach the hospital or the ER. The researchers suggested that this may be especially true of cardiac arrest patients.
•    Noting that there hasn’t been a significant decrease inpatient deaths. Researchers say that it might be that more patients are surviving in the ED, but die after being admitted to the hospital.
•    Substantial improvements have been made in treating life-threatening conditions like stroke, trauma and sepsis, including more effective therapies and enhanced training in critical care.
•    Patients are more likely to die in a hospice center or under hospice care at home than they were 15 years ago. Between 1989 and 2007, the number of home deaths increased by over 50%, causing hospital deaths to drop by more than 20%.

The study's authors cautioned that better mortality rates shouldn't be used as a quality metric for emergency physicians, noting that 62% of ER visits resulting in patient deaths happened when the patient was in cardiac arrest, unconscious or dead upon arrival.