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The Incidence and Severity of Adverse Events Affecting Patients after Discharge from the Hospital
- Alan J. Forster, MD, FRCPC, MSc;
- Harvey J. Murff, MD;
- Josh F. Peterson, MD;
- Tejal K. Gandhi, MD, MPH; and
- David W. Bates, MD, MSc
- From University of Ottawa, Ottawa, Ontario, Canada; and Harvard Medical School, Boston, Massachusetts.
Abstract
Background: Studies of hospitalized patients identify safety as a significant problem, but few data are available regarding injuries occurring after discharge. Patients may be vulnerable during this transition period.
Objective: To describe the incidence, severity, preventability, and “ameliorability” of adverse events affecting patients after discharge from the hospital and to develop strategies for improving patient safety during this interval.
Design: Prospective cohort study.
Setting: A tertiary care academic hospital.
Patients: 400 consecutive patients discharged home from the general medical service.
Measurements: The three main outcomes were adverse events, defined as injuries occurring as a result of medical management; preventable adverse events, defined as adverse events judged to have been caused by an error; and ameliorable adverse events, defined as adverse events whose severity could have been decreased. Posthospital course was determined by performing a medical record review and a structured telephone interview approximately 3 weeks after each patient's discharge. Outcomes were determined by independent physician reviews.
Results: Seventy-six patients had adverse events after discharge (19% [95% CI, 15% to 23%]). Of these, 23 had preventable adverse events (6% [CI, 4% to 9%]) and 24 had ameliorable adverse events (6% [CI, 4% to 9%]). Three percent of injuries were serious laboratory abnormalities, 65% were symptoms, 30% were symptoms associated with a nonpermanent disability, and 3% were permanent disabilities. Adverse drug events were the most common type of adverse event (66% [CI, 55% to 76%]), followed by procedure-related injuries (17% [CI, 8% to 26%]). Of the 25 adverse events resulting in at least a nonpermanent disability, 12 were preventable (48% [CI, 28% to 68%]) and 6 were ameliorable (24% [CI, 7% to 41%]).
Conclusion: Adverse events occurred frequently in the peridischarge period, and many could potentially have been prevented or ameliorated with simple strategies.
Article and Author Information
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Grant Support: By an R. Samuel McLaughlin Fellowship (Dr. Forster).
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Potential Financial Conflicts of Interest:Consultancies: D.W. Bates; Honoraria: D.W. Bates.
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Requests for Single Reprints: David W. Bates, MD, MSc, Division of General Medicine, Brigham and Women's Hospital, PBB-A3, 75 Francis Street, Boston, MA 02115; e-mail, dbates{at}partners.org.
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Current Author Addresses: Dr. Forster: University of Ottawa, F654-1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada.
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Drs. Murff, Peterson, Gandhi, and Bates: Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.
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Author Contributions: Conception and design: A.J. Forster, T.K. Gandhi, D.W. Bates.
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Analysis and interpretation of the data: A.J. Forster, H.J. Murff, J.F. Peterson, T.K. Gandhi, D.W. Bates.
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Drafting of the article: A.J. Forster.
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Critical revision of the article for important intellectual content: A.J. Forster, H.J. Murff, T.K. Gandhi, D.W. Bates.
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Final approval of the article: A.J. Forster, H.J. Murff, J.F. Peterson, T.K. Gandhi, D.W. Bates.
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Provision of study materials or patients: A.J. Forster, D.W. Bates.
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Statistical expertise: A.J. Forster, D.W. Bates.
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Obtaining of funding: A.J. Forster.
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Administrative, technical, or logistic support: A.J. Forster, D.W. Bates.
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Collection and assembly of data: A.J. Forster.
- Copyright ©2004 by the American College of Physicians
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