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Prehospital vs. emergency department pronouncement of death: a cost analysis

Published online by Cambridge University Press:  21 May 2015

Mathew Cheung ,
Laurie Morrison  and
P. Richard Verbeek
Mathew Cheung
Affiliation:
Department of Emergency Services, Sunnybrook and Women’s College Health Sciences Centre, Toronto, and Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ont
Laurie Morrison*
Affiliation:
Division of Prehospital Care, Department of Emergency Services, Sunnybrook and Women’s College Health Sciences Centre, Toronto, and Division of Emergency Medicine, Department of Medicine, University of Toronto, and Toronto Ambulance Services, Toronto
P. Richard Verbeek
Affiliation:
Division of Prehospital Care, Department of Emergency Services, Sunnybrook and Women’s College Health Sciences Centre, Toronto, and Division of Emergency Medicine, Department of Medicine, University of Toronto, and Toronto Ambulance Services, Toronto
*
Sunnybrook and Women’s College Health Sciences Centre, Rm. BG20, 2075 Bayview Ave., Toronto ON M4N 3M5; 416 480-6056, fax 416 480-6797; phc.research@utoronto.ca

Abstract

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Objective:

National survival rates for out-of-hospital cardiac arrests are less than 5%, and substantial resources are associated with transporting cardiac arrest victims to hospital for emergency department (ED) resuscitation. The low overall survival rate and the identification of predictors of unsuccessful resuscitation have opened debate on the “futility” of transporting such patients to the ED. This study compares the costs of prehospital pronouncement of death to the costs of transporting patients to a hospital ED for physician pronouncement.

Methods:

The study was a retrospective chart review on a matched cohort of out-of-hospital cardiac arrest patients. Patients were included if documentation was adequate and ambulance response time was less than 8 minutes. A cohort of 20 patients pronounced dead in the field were matched to 20 patients pronounced dead in an ED. Cases were matched on 6 evidence-based predictors of unsuccessful resuscitation. Direct medical costs and mean physician and prehospital provider times were compared.

Results:

The total cost of pronouncement of death in the ED was $45.35 higher than the cost of field pronouncement (p < 0.001). Paramedics spent more time delivering care when death was pronounced in the field (83.3 vs. 55.9 min; p < 0.001). Base hospital physicians spent more time when patients were transported to hospital for ED pronouncement (16.3 vs. 4.3 min; p < 0.001). Total provider time for field pronouncement was 15.5 min longer (p = 0.004), but field pronouncement consumed 12.0 min less physician time.

Conclusions:

Paramedic pronouncement of death in the field is less costly than transporting patients to hospital for physician pronouncement. Pronouncement in the field requires more paramedic time but less physician time.

Keywords

emergency medical servicesdeath pronouncementcost identification
Type
Em Advances • Progrès De La MU
Information
Canadian Journal of Emergency Medicine , Volume 3 , Issue 1 , January 2001 , pp. 19 - 25
Copyright
Copyright © Canadian Association of Emergency Physicians 2001

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