Thread by @jimbuctwit

Inpatient and Outpatient Deaths - Distinctions of Honor

South Dakota Dept of Health @SDDOH reports deaths among SD residents as either INPATIENT or OUTPATIENT.

The death location might seem academic but I think there’s something to it.

A rambling THREAD…

I have no special info from DoH re location criteria but I suspect it’s fairly straightforward.

If you die while ADMITTED TO HOSPITAL then you are tallied as INPATIENT death.

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Any death not labeled inpatient is OUTPATIENT.

Outpatient deaths would included deaths at NURSING HOMES, ASSISTED-LIVING facilities and other elder care facilities. I believe these locations would be the source of most outpatient deaths.

Deaths at home are also outpatient.

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I worked as a geriatrician at a large university and in the VA Health Care system for my entire career. I frequently cared for elderly, dying patients & their families in hospitals, hospices and at their homes. End-of-life care is no stranger to me.

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It might sound cliché, but many frail, failing elderly will say they’ve lived a full life & don’t fear death. In fact, they fear prolongation of the dying process & consequently make the brave choice to forego aggressive, life-prolonging treatments in hospitals.

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They want to stay "home" & be comfortable. Fortunately families & health care providers are getting more comfortable accepting “comfort measures only” as a ACTIVE process of care thus allowing the wishes of dying parents and grandparents to be met with compassion.

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I’m sad to hear of COVID deaths among outpts, especially since, to a degree, they were preventable. Sir Wm. Osler, “father of modern medicine” said something like: “pneumonia is the old man’s friend” as it was a painless way to die. I suppose some outpatients welcome death.

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But, I am especially sad to hear of COVID deaths among INPATIENTS because unlike outpatients described above (and of course not all outpatients are elderly, frail, etc.), people go to the hospital to fight COVID because they WANT TO LIVE. They’re not “ready” to die.

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So, the INPATIENT distinction for me highlights the number of South Dakotans who DIED WHILE FIGHTING TO LIVE, regardless of age. It highlights the number people who did not welcome a preventable death due to a contagious disease.

END