Adverse Events after Hospital Discharge

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The summary below is from the full report titled "The Incidence and Severity of Adverse Events Affecting Patients after Discharge from the Hospital." It is in the 4 February 2003 issue of Annals of Internal Medicine (volume 138, pages 161-167). The authors are AJ Forster, HJ Murff, JF Peterson, TK Gandhi, and DW Bates.

What is the problem and what is known about it so far?

Patients sometimes suffer complications as a result of medical management. Patients can also suffer complications that are a direct result of their illness, but these do not fall under the definition of an adverse event. There has been much recent concern about the number of adverse events that occur in hospitals. The transition from hospital to home is another time when adverse events might occur. However, previous studies of adverse events have focused on the hospital period rather than the time after patients go home.

Why did the researchers do this particular study?

To describe the frequency and severity of adverse events that occur after a patient is discharged from the hospital.

Who was studied?

400 patients discharged home after a hospital stay on the general medicine service of one teaching hospital.

How was the study done?

The researchers created a file for each patient that included information from the patient's medical record and from a telephone interview. The telephone interview occurred 2 to 5 weeks after the patient left the hospital. The interviewers asked about patients' health, symptoms, and medical care since hospital discharge. Two of the researchers reviewed each file to determine whether an adverse event occurred. Adverse events included new or worsening symptoms, unanticipated health care visits, or deaths. For each adverse event, they rated its severity and gave their opinion about whether the event could have been prevented or made less severe.

What did the researchers find?

Of the 400 patients in the study, 76 experienced an adverse event after hospital discharge. The researchers judged that 23 of these patients had preventable adverse events and 24 had adverse events that could have been made less severe by appropriate medical management. The adverse events included laboratory abnormalities and symptoms. Most adverse events were related to drugs or procedures and did not result in permanent disability.

What were the limitations of the study?

The study involved patients from one service of one hospital. The results might not apply to other settings. In addition, the researchers relied on medical records and telephone interviews to determine whether an adverse event occurred. This method may be imprecise.

What are the implications of the study?

Adverse events can occur after hospital discharge. The transition from hospital to home is a potentially vulnerable period. The medical community should explore ways to reduce adverse events during this transition.