Bay Area Hospital's risk adjusted stroke mortality rate for the year 2007 was noted to be 12.8% with an expected rate of 5.9%. Eight (8) mortalities were noted and reviewed.
Of these mortalities, three were large intracranial bleeds with one a large subdural, who presented to the emergency department. All three intracranial bleeds were discussed with a neuro-surgeon and felt these patients were not candidates for transfer. The large subdural could not be transferred to a neuro-surgeon quickly due to lack of available transport, and expired a no code within 24 hours.
Four of the eight patients were strokes; one was 93 years old and one was 98 years old both found unresponsive and not lytic candidates. One was 78 years old and had a stroke in spite of being on warfarin (inr 3.0) and not a lytic candidate. The last patient was 77 years old and came in unresponsive with the request by family for no heroic measures and died.
The case reviewers determined that there were no quality of care issues with the exception of the inability to rapidly transfer one case of subdural bleed due to no fault of Bay Area Hospital. This patient expired so quickly that it appears the transfer would not have helped.
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