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Risk of death within 7 days of discharge from emergency departments with different organizational models

Moellekaer, Andersa,b,e,f; Kirkegaard, Hansa,b,e; Vest-Hansen, Betinaa,e; Duvald, Ibenb,d; Eskildsen, Jacobb,c; Obel, Borgeb; Madsen, Bog

doi: 10.1097/MEJ.0000000000000596
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Objective The aim of this study is to investigate the association between emergency department (ED) organizational models and the risk of death within 7 days of ED discharge.

Patients and methods We included Danish ED discharges between 1 January 2011 and 24 December 2014 that led to death within 7 days of discharge. The inclusion criterion was age older than 18 years. The exclusion criterion was further in-hospital admission. First model (Virtual): other departments employ interns who perform ED tasks. They are responsible for ED patient care and prioritize their task order between their own department and the ED.

Second model (Hybrid): the ED/other departments perform tasks; interns/consultants are employed by the ED/other departments. The ED/other departments have patient care responsibility.

Third model (Independent): the ED performs all tasks; employs interns/consultants; and have patient care responsibility.

Sex, age, Charlson Comorbidity Index score, and primary diagnosis were used to describe patient characteristics. We calculated the risk of death within 7 days of discharge using multiple logistic regression analysis.

Results In 805 out of 201 299 discharges included in the study, the patient died within 7 days. Compared with the Virtual model, the odds ratio for death within 7 days of discharge was 0.72 (95% confidence interval: 0.59–0.92) for the Independent model and 0.75 (95% confidence interval: 0.61–0.92) for the Hybrid+Virtual model. Increased risk was associated with male sex, older age, and a medium or a high Charlson Comorbidity Index score.

Conclusion Compared with discharges from a Virtual model, the risk of death within 7 days of discharge was lower if the ED had an Independent or a Hybrid+Virtual model.

aDepartment of Clinical Medicine, Research Center for Emergency Medicine

bDepartment of Management, Interdisciplinary Center for Organizational Architecture, Aarhus University

cDepartment of Management

dDepartment of Business Development and Technology, School of Business and Social Sciences, Aarhus University

eDepartment of Emergency Medicine, Aarhus University Hospital, Aarhus

fEmergency Department, The regional Hospital West, Herning, Denmark

gDepartment of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA

Correspondence to Anders Moellekaer, MD, MBA, PhD, Research Center for Emergency Medicine, Institute of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 161, J103-251, 8200 Aarhus N, Denmark Tel: +45 20 848 304; e-mail: anders.moellekaer@clin.dk

Received July 13, 2018

Accepted December 19, 2018

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