Are these ER patients dead or alive?

January 12th, 2015

Would you believe that some intubated emergency patients are recorded as having both died in the ER and been admitted to the ICU?

According to the National Hospital Ambulatory Medical Care Survey (NHAMCS), a report produced by the Centers for Disease Control and Prevention, one-quarter of intubated emergency patients are either discharged from the hospital or admitted to a non-critical care unit, which is medically impossible.

The report, which was an analysis of 10 years of NHAMCS reports, raises serious questions about the accuracy and reliability of NHAMCS data on intubated patients.

The report, authored by Steven Green, MD, Loma Linda University Medical Center in Loma Linda, CA, analyzed 875 emergency department visits in which a patient was intubated. The NHAMCS recorded that 9% of those patients were discharged from the hospital and 17 percent were admitted to a non-critical care unit. In 37 of these visits, disposition was recorded multiple ways, with 11 patients recorded as both dead and alive. Intubated patients either die or are admitted to a critical care unit.

"Eleven patients were recorded as having both died in the ER and been admitted to the ICU," said Dr. Green. "In addition, while it is theoretically possible that a patient could be intubated, extubated, and discharged, it would be a highly unusual circumstance. It is impossible to believe that more than one-fourth of these patients were placed anywhere other than the ICU or the morgue, and yet that is what 10 years of federal reports indicate. Something doesn't add up."

"In view of how much the medical community has come to depend upon and trust the NHAMCS database, these findings are troubling," said Dr. Green. "NHAMCS is overall a fabulous program with a talented, dedicated staff. However, it is clear that some important data elements are not being accurately abstracted, and that greater attention to the reliability of the chart review process is necessary."