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Preventing unnecessary deaths and improving patient care

Death by an Adrenal Crisis (AC) can occur at any time, wether Addison’s Disease has been diagnosed and is being treated
or is yet to be diagnosed. Research by Rushworth, Louise & Torpy, David & Falhammar, Henrik (2017) found that Adrenal
Crisis (AC) “account for a substantial proportion of all AI deaths” 1
. In fact, as a result of an AC, the mortality rate for
patients with treated AI increases substantially “being responsible for up to 15% of all deaths in autoimmune AI”
2
.
These unnecessary deaths can be successfully prevented through access to timely medical treatment3
.
A national protocol in hospitals that enables patients with Addison’s Disease to be triaged appropriately and receive
prompt medical treatment is the best way to prevent unnecessary deaths by AC. This solution has been suggested before.
On 11 May 2007, the State Coroner of Western Australia made a number of recommendations regarding the recognition
of serious illnesses in a general practice setting, as the result of the preventable death of a 16 year old patient from
Addison disease4
. An article in the ABC news in 2015 reported on the avoidable death of two people from undiagnosed
Addison’s disease. The Coroner’s recommendation to the NSW Ministry of Health to publish a “Patient Safety Watch” to
local health districts would increase awareness of the disease and help save lives5
.
Timely medical care will not only save lives, it will also save money and reduce the burden on the public health system.
The severity of an AC is affected by how quickly medical treatment is administered. The longer it takes to receive medical
treatment, the more severe the AC and the longer the recovery period. This often results with the patient being admitted
into Intensive Care and as an in-patient in hospital for several days or more. According to an article published in the
Medical Journal of Australia, the “estimated mean cost per patient bed‐day” in ICU was $4375 (the equivalent of $4875 in
2019)6
. The annual “operational cost for ICU care in Australia was $2119 million, about 0.15% of gross domestic product
(GDP) and 1.4% of total health care costs”7
.
Even if a patient with Addison’s does not require treatment in ICU they will likely require to be admitted as an in-patient
to stabilize and recover. The Australian Institute of Health and Welfare estimated the average cost of care in 2014-2015 to
range “from $3,300 at one hospital to $6,400 at another”8
.
The solution is simple. Timely medical care in Emergency Departments will save lives and reduce medical costs as the
hospital admission stay and recovery time will be shorter.
The reality is not that simple. Time and time again, patients have reported waiting hours in Emergency Departments
across Australia, while their condition deteriorated, because of a lack of awareness of the seriousness and gravity of
Addison’s disease.
For all the reasons explained above, and the tragic examples of unnecessary deaths as well as the medical statistics of
increased mortality rates, I am working towards the implementation of a national protocol for hospitals in correctly
triaging patients with Addison’s Disease so they can receive prompt medical treatment. This will not only save lives but
also save money by reducing the need for ICU and long hospital admissions, thereby reducing the burden on the public
health system.

1-(Rushworth, Louise & Torpy, David & Falhammar, Henrik. (2017). Adrenal crises: perspectives and research directions.
Endocrine. 55. 1-10. 10.1007/s12020-016-1204-2. page 1)
2-Ibid page 3
3-Ibid page 3
4-Medical Defence Association of Western Australia, Professional Practice Risk Management, Failure to diagnose: Addison
disease
5-Court calls for ‘safety watch’ after two young lives taken by undiagnosed Addison’s disease By Nicole Chettle, Updated 2 Dec
2015, 5:01pm http://www.abc.net.au/news/2015-12-02/court-calls-for-safety-watch-in-addisons-disease-inquest/6994504
6-Peter Hicks, Sue Huckson, Emma Fenney, Isobel Leggett, David Pilcher and Edward Litton (2019) Medical Journal of Australia;
211 (7): 324-325. || doi: 10.5694/mja2.50309
7-Ibid
8-The Australian Institute of Health and Welfare, https://www.aihw.gov.au/reports-data/myhospitals/intersection/spending/apc

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