Analysis of influencing factors of death in emergency observation room patients and suggestions for improvement countermeasures

Objective To understand the characteristics of patients in the emergency observation room, analyze the factors influencing death, and provide orientation for improving the level of emergency treatment in the hospital.

Methods The data of all patients discharged from the emergency observation room in a tertiary hospital in Shanghai from January 1 to December 31, 2019 were collected. The patients were divided into the death group and the survival group based on their outcome. The clinical data of two groups were compared, and the characteristics of death cases were analyzed.

Results In 2019, there were 2 211 patients discharged from the emergency observation room, including 125 deaths and 2 086survivors. Among the surviving patients, 1 183 were discharged(accounting for 56.71%), and 903 were admitted to specialized departments for further treatment(accounting for 43.28%). The median(25th, 75th percentile) observation time was 2.50(1.00, 9.00) days, and 1 076 patients(accounting for 48.67%) had an observation time longer than 72 h. The average age was(67.81 ± 18.87) years, and males accounted for 57.98%(1 282 cases). The death group had a higher incidence of respiratory system diseases and malignant tumors than the survival group, while the survival group had a higher incidence of nervous system diseases(P < 0.01). The frequencies of using non-invasive ventilators and electrocardiogram monitoring in the death group were higher than those in the survival group(P < 0.01). The peak period of death occurrence was mainly in the winter. The multivariate logistic regression analysis showed that the risk of death increased to 1.057 and 1.013 times for every 1 year increment of age and every 1 day increment of staying in observation time, respectively(P < 0.001); the risk of death for patients with two or more diagnosed diseases was 3.873 times that of patients with one diagnosis(P < 0.001); compared with patients from the clinic, the risk of death for patients from the rescue room increased to 2.877 times(P < 0.001).

Conclusions The hospital should standardize the triage and treatment of critically ill and complicated patients, allocate and distribute emergency resources reasonably, and strengthen the observation of the condition. Effective prevention and treatment strategies should be formulated based on high-risk factors such as old age, respiratory system diseases, tumors, and seasonal variations to improve the efficiency and quality of emergency treatment.