Objectives and Background The Medway Maritime District General Hospital's Emergency Department (ED) had a patient census of 84 000 in 2009. Monthly adverse events in 2008 and 2009 prompted a 48-h post admission mortality audit in July 2009 which identified multiple hospital and departmental failings with some related to a chain of missed events. Changes to clinical and operational practices within the department were implemented. These include: reducing Inappropriate Observation Ward admissions, the greater use of the Medway Modified Early Warning System scores, early Clinical Intervention by senior ED doctors and on-call teams, reducing the length of stay of critical care patients, improving Written and Chart Documentations, and changes to Staffing Rota & Skill-mix. The impact of these changes was re-audited in 2010.

Method The demographic and clinical / nursing records of patients who died within 48-h of admission and were seen by an ED doctor were analysed for July 2009 and January 2010. Patients seen by other admitting specialities were excluded.

Result 7326 and 6664 patients registered in July 2009 and January 2010 respectively. The majority of patient deaths occurred in the medical and surgical units. Both audited groups had similar age, age range, and sex distribution, and mortality demographics (14 and 13 deaths respectively).The emergency department had no recorded deaths in January 2010 and continued to record zero mortality for several months in 2010.

Conclusions The 48-h mortality audit could be an effective quality evaluation tool for EDs. Changes to operational practices and attitudes towards patient care and mortality reduction require a systematic programme of changes across an organisation and are not solely the responsibility of any one department.