Adverse events: an expensive and avoidable hospital problem

Abstract

Introduction Adverse healthcare-related events (AE) entail reduced patient safety. Estimating their frequency, characteristics, avoidability and impact is a means to identify targets for improvement in the quality of care. Methods This was a descriptive observational study conducted within the Patient Safety Incident Study in Hospitals in the Community of Madrid (ESHMAD). The study was conducted in a high-complexity hospital in May 2019 through a two-phase electronic medical record review: (1) AE screening and epidemiological and clinical data collection and (2) AE review and classification and analysis of their impact, avoidability, and associated costs. Results A total of 636 patients were studied. The prevalence of AE was 12.4%. Death during the stay was associated with the presence of AE (OR [CI95%]: 2.15 [1.07 to 4.52]) versus absence and emergency admission (OR [CI95%]: 17.11[6.63 to 46.26]) versus scheduled. A total of 70.2% of the AEs were avoidable. Avoidable AEs were associated with the presence of pressure ulcers (OR [CI95%]: 2.77 [1.39 to 5.51]), central venous catheter (OR [CI95%]: 2.58 [1.33 to 5.00]) and impaired mobility (OR [CI95%]: 2.24[1.35 to 3.71]), versus absences. They were associated too with the stays in the intensive care unit (OR [CI95%]: 2.75 [1.07 to 7.06]) versus medical service. AEs were responsible for additional costs of €909,716.8 for extra days of stay and €12,461.9 per patient with AE. Conclusions The prevalence of AEs was similar to that found in other studies. AEs led to worse patient outcomes and were associated with the patient’s death. Although avoidable AEs were less severe, their higher frequency produced a greater impact on the patient and healthcare system. Key messages Adverse events are one of the main problems in healthcare delivery and patients who suffer from at least one AE are double as likely to die during hospitalization. Avoidable adverse events are the most frequent in health care and they are a good target where achieve improvement areas that allow getting optimal patient safety and quality of care levels. Patients hospitalized in the ICU, with the previous presence of pressure ulcers, central venous catheter, or impaired mobility were associated with the development of avoidable AE, so optimal management of these patients would reduce the impact of AE.

Inappropriate Hospital Admission According to Patient Intrinsic Risk Factors: an Epidemiological Approach

“…Among the strength of this study, the following are especially relevant: (1) this is the first study that uses the AEP in an epidemiological perspective, analyzing how IRFs influence hospital admissions; (2) to the best of our knowledge, this study is also a pioneer in applying a cross-sectional design to all patients admitted to a hospital and in providing a prevalence value for inappropriate admission; (3) last, the patients' IRFs included were collected using the same criteria established by studies of recognized prestige in the field of patient safety, such as ESHMAD 17,18,42 (based on the methodology of The Harvard Medical Practice Study) 19 and EPINE. 20 Finally, the inappropriateness of admissions results in a problem of great magnitude within health care due to its frequency and economic impact.…”

“…This study was conducted simultaneously and applying the same inclusion criteria as other cross-sectional patient safety studies, such as the Study on Patient Safety in Hospitals in the Community of Madrid (ESHMAD) 17,18 20 , which has been carried out annually since 1990 in all high complexity hospitals in Spain and whose protocol was adapted by the ECDC to carry out the Point Prevalence Survey of Healthcare-associated Infections at the European level 21 , making it possible to calculate spatial-temporal trends in the prevalence of health care-associated infections. Based on this structure, a cross-section of patients was taken from each hospital ward on a date other than the first and last working days of the week to avoid overrepresentation of admissions or discharges.…”

“…11 The following patient-related variables were considered: age; sex; IRFs; Charlson comorbidity index; reason for patient discharge ('death', 'transfer', or 'discharge'); and prognosis of the disease leading to admission, classified as per the validated MRF2 form used in the ESHMAD study ('full recovery to baseline', 'recovery with residual disability', and 'terminal illness'). 17,18 The IRFs were the clinical data of patients associated with the development of complications and adverse events related to health care that were collected on admission. These were collected on admission and logged as dichotomous variables, considering the 'presence' or 'absence' of the factor, based on the criteria established by the ESHMAD 17 and EPINE 20 studies.…”

Patient and family engagement interventions for hospitalized patient safety: A scoping review

“…In hospital settings, the overall incidence of adverse events was high (9.2%), with 43.5% being preventable (de Vries et al., 2008). These adverse events increased patient suffering, prolonged the intensive care unit stay and raised the risk of in‐hospital death (San Jose‐Saras et al., 2022). A study pointed out that approximately $30,000 in additional index stay costs per harm was caused by the most expensive adverse events such as surgical site infections and severe pressure sores, and $6000–$13,000 was added by lower‐cost adverse events such as catheter‐associated urinary tract infections and venous thromboembolism (Anand et al., 2019).…”

Working Condition and Job Satisfaction of Nurses as Predicting Factors of the Prevalence of Health care-associated Infections among Elderly Inpatients

“…[ 3 ] AEs increase the Length of Stay (LOS), cause unfavorable patient output, and impose huge costs on health systems. [ 4 ] The determinants of AEs include healthcare system, factors associated with the healthcare professionals, and nature of the medical sciences. [ 3 ] HCAIs are among the most common AEs in healthcare systems,[ 5 ] and they refer to infections that patients may develop more than 48 hours after receiving healthcare services.…”