We’ve come lately to the Scrubs fan club - and have just started plowing through the early episodes courtesy of Netflix.
Disk 1 had a couple of things that puzzled me. One was a statement that “aside from Maternity and the ER, 1/3 of the people who check into a hospital don’t survive”. Is that a semi-real statistic?
Another one was: an older woman (74ish) was in renal failure and opted not to go for dialysis, saying she was ready to die. The show implied she died within a few hours. Surely it’s not that fast, is it? I would assume it would be days, weeks even.
My dad went to the ER when his kidneys failed. He was airlifted to Albuquerque, which would have been only a one hour drive. You’re right in that it would take days or weeks, but by the time the problem presents symptoms urgent enough to seek medical attention, a large part of said days or weeks may have already been used up.
The first statistic is nonsense. Is there any chance they were referring to adult Intensive Care Unit data?
As to renal failure: I don’t watch TV shows, so I can’t comment on the Scrubs episode. However if the woman had been diagnosed with renal failure late in the game and her electrolyte balance was severely abnormal, it might only take hours to die from the time at which the diagnosis was made or presented to her. In particular if her potassium was dangerously high when the renal failure was diagnosed, that might be an indication for emergency dialysis, absent which death might ensue within hours. If she began with normal renal function and her kidneys shut down from some catastrophic event, her time would be measured in days (depending on the cause for the shutdown and an assortment of other conditions). Most renal insufficiency is not absolute and most causes of it take time to develop–years, in many cases.
The result showed that the observed death rate decreased from 2.22% of all patients in 1998 to 1.92% during the first six months of 2006. …CHI tracked patient acuity information on more than 24 million patients discharged from more than 2,000 hospitals. …1.02 million patients died in 1998 subtracted by an annualized total of 673,952 in 2006
1.92% seems crazy low though, even including Maternity and ER.
Ok,
In a 3 month stint as an intern in a major cardiology/cardiothoracic unit I verified perhaps 4 deaths. That’s a 50-bedded unit. I don’t think any of my colleagues would have seen mare, so that’s perhaps 20 deaths in 3 months on a fully occupied cardiology ward, 20 out of perhaps 500.
In a 3 month stint doing general medicine in a 70 bedded regional hospital where the average patient was over 70, a nursing home resident and admitted to hospital for their last illness, I’d say the rate was about 1 in 5.
In 3 months of respiratory medicine only 2 of my patients died, with perhaps 5 deaths overall (out of 50 beds, over 3 months).
In 3 months of Vascular, general and colo-rectal surgery we had 3 deaths, full-stop, this time out of 100 beds.
In three months of Obs and gynae (which includes gynae oncology), we have had no in patient deaths of any women.
So, if you’re talking about general medicine or geriatrics, in an area with an elderly population, a 70% DNR rate and hospital admission where the patient is not expected to die, then yes, 1 in 3 is about right. Otherwise, not so much.
Complete renal failure can kill you quickly (within hours), if you are anuric (not making any urine at all) and aren’t dialysed. If you’re still making some amount of urine it would be rather slower.
Sorry.
“So, if you’re talking about general medicine or geriatrics, in an area with an elderly population, a 70% DNR rate and hospital admission where the patient **is ** expected to die, then yes, 1 in 3 is about right. Otherwise, not so much.”
Sorry for not popping back in earlier to thank y’all for the replies… was busy for a couple of days and got distract - ooooooh, shiny!!!
Anyway - I thought that statistic (1/3 death rate) was hooey. Even assuming they were working strictly the ICU (which I don’t think was implied) that would (I hope!) be higher than reality.
Interesting on the kidney failure. They didn’t specifically say she was totally anuric, and she was well enough to sneak out of the hospital to attend her granddaughters birthday party, but then maybe her kidneys were just in the process of shutting down.
Yeah - it was a hernia, which wouldn’t seem like something to put you in the ICU, then they stumbled across some sort of cancer (lymphoma); while the cancer might have eventually killed him it didn’t seem like it was that imminent. And JD’s patient - while kidney shutdown could certainly put one in the ICU, she clearly was not an ICU patient at first (most ICU patients are surely not well enough to stage a jailbreak!).
In short - entertaining show but made-up statistics.
