Adverse Outcomes Associated with Preventable Complications in Hospitalized Patients with CKD

Bohlouli, Babak; Jackson, Terri; Hemmelgarn, Brenda R.; Klarenbach, Scott

doi:10.2215/cjn.09410916

Cited by 10 publications

(13 citation statements)

References 15 publications

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“…Hospital institutions began to pay attention to this aspect, but trying to maintain an excellent service and ensure customer satisfaction; to that end, patient safety was established as the main objective 32 . Therefore, the literature emphasizes that HAC may be a result of problems in practice, products, processes or systems, and that their occurrence results from a chain of systemic factors 1 . We reinforce that studies in hospitals in several countries show the association between HAC and increased length of stay, one of the patient safety indicators 3,6,33,34 .…”

Section: Discussionmentioning

confidence: 99%

“…Hospital-acquired conditions ((HAC) are undesirable or adverse events that directly affect the patient’s health and experience in hospital care 1 . They refer to the medical conditions or complications developed during the hospitalization period that were not present at the time of admission 1 . Generally, they result in additional costs, generated both by the increase in hospital stay and by the subsequent treatments 2 .…”

Section: Introductionmentioning

confidence: 99%

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Hospital-acquired conditions and length of stay in the pregnancy and puerperal cycle

et al. 2019

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OBJECTIVE: To analyze the impact of the Hospital-Acquired Conditions (HAC) in women in the puerperal and pregnancy cycle during length of stay. METHODS: This cross-sectional study was conducted with 113,456 women, between July 2012 and July 2017, in Brazil’s national hospitals of the supplementary healthcare networks and philanthropists accredited to the Unified Health System (SUS). Data on hospital discharges were collected using the Diagnosis-Related Groups (DRG Brasil) system. All DRGs of the major diagnostic category 14 (MDC14), including pregnancy, childbirth and puerperium, were included. The impact of HAC on length of stay was estimated by Student’s t-test, and the effect size by Cohen’s d, which allows to assess clinical relevance. RESULTS: The most prevalent diagnostic categories related to MDC14 were vaginal and cesarean deliveries without complicating diagnoses, both at institutions accredited to SUS and those for supplementary health care. The prevalence of HAC was 3.8% in supplementary health and 2.5% in SUS. Hospitals providing services to supplementary health care providers had a longer length of stay considering HAC for patients classified as DRG: cesarean section with complications or comorbidities at admission (p < 0.001; Cohen’s d = 0.74), cesarean section without complications or comorbidities at admission (p < 0.001, Cohen’s d = 0.31), postpartum and post abortion without listed procedure (p < 0.001, Cohen’s d = 1.05), and other antepartum diagnoses with medical complications (p < 0.001; Cohen’s d = 0.77). CONCLUSIONS: This study showed that the prevalence of HAC was low both in the institutions accredited to attend by SUS and in those of supplementary health; however, its presence contributes to increasing the length of stay in cases of cesarean sections without complications or comorbidities in supplementary health institutions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hospital-acquired conditions and length of stay in the pregnancy and puerperal cycle

et al. 2019

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“…Individuals living with CKD often have serious comorbidities, may require the need for invasive treatments such as dialysis and an increased likelihood of frequent hospitalizations [5]. Safety incidents associated with hospitalization, such as nosocomial infections, missed laboratory results, and medication errors, may predispose these patients to further kidney damage and increased lengths of stay [6–9, 18, 19].…”

Section: Introductionmentioning

confidence: 99%

“I just have to take it” – patient safety in acute care: perspectives and experiences of patients with chronic kidney disease

New

Goodridge

Kappel

et al. 2019

BMC Health Serv Res

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Background Frequent hospitalizations and dependency on technology and providers place individuals with chronic kidney disease (CKD) at high risk for multiple safety events. Threats to their safety may be physical, emotional, or psychological. This study sought to explore patient safety from the perspectives and experiences of patients with CKD in acute care settings, and to describe willingness to report incidents utilizing an existing safety reporting system. Methods This study was conducted using a qualitative interpretive descriptive approach. Face to face interviews were conducted with 30 participants at their bedside during their current hospital admission. The majority of the participants were 50 years or older, of which 75% had a confirmed diagnosis of end stage renal disease with the remainder at stages 3 or 4 of CKD. Eighty percent of the participants were either on hemo- or peritoneal dialysis. Results Participants expected to receive safe care, to be taken care of, and to be cared for. Safety threats included: sharing a room with patients who were on precautions; lack of cleanliness; and roommates perceived to be threatening. The concepts of being taken care of and being cared for constituted the safety threats identified within the interpersonal environment. Participants felt taken care of when their physical needs are met and cared for when their psychological and emotional needs are met. There was a general lack of awareness of the presence of a safety reporting system that was to be accessible to patients and families by telephone. There was also an overall unwillingness to report perceived safety incidents, although participants did distinguish between speaking up and reporting. Conclusions A key finding was the unwillingness to report incidents using the safety reporting system. Fear of reprisals was the most significant reporting impediment expressed. Actively inviting patients to speak up may be more effective when combined with a psychologically safe environment in order to encourage the involvement of patients in patient safety. System-wide organizational changes may be necessary to mitigate emotional and physical harm for this client population. Electronic supplementary material The online version of this article (10.1186/s12913-019-4014-4) contains supplementary material, which is available to authorized users.

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“…The data elements have use beyond ABF and have been effective for clinical epidemiological studies, research into the quality of health care and patient safety, utilisation review, and for providing demographic, financial, cost, and length of stay information. With clinician review of ABF data, length of stay decreases, more efficient models of care have emerged, and considerable efforts have been directed to minimise complications of care (Bohlouli, Jackson, Tonelli, Hemmelgarn, & Klarenbach, ; Larg, Moss, & Spurrier, ). Even so, there remain considerable gaps between the policy volume of work produced and its use by clinicians, administrators, and planners (McCrow, ).…”

Section: Discussionmentioning

confidence: 99%

Activity‐based funding for safety and quality: A policy discussion of issues and directions for nursing‐focused health services outcomes research

Heslop

2019

Int J of Nursing Practice

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Aims A discussion of the implications and opportunities arising from the Commonwealth of Australia health care reform agenda; linking pricing with quality, with particular reference to directions for nursing‐focused health services outcomes research directed to improve the safety and quality of health care practices. Background National activity‐based funding in Australia is a policy‐focused development. As the relationship between cost and quality becomes apparent, the role of clinicians and their contribution to high quality care has become a pressing issue for leadership, teaching, and research. Design Discussion paper Data Sources This paper is based on seven years' experience as a member of a Commonwealth of Australia statutory committee—the Clinical Advisory Committee of the Independent Hospital Pricing Authority—and is supported by relevant literature and theory. Implications for Nursing To date, unravelling the linkage, especially causal relationships, between direct care nursing and patient safety outcomes has not been well established. New activity‐based funding data elements developed for national implementation in Australia provide accessible and meaningful standardised data for measurement of never events, hospital‐acquired complications, and preventable readmissions.

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Adverse Outcomes Associated with Preventable Complications in Hospitalized Patients with CKD

Abstract: Preventable HACs are associated with higher mortality, incremental LOS, and greater risk of readmission, especially in people with CKD. Targeted strategies to reduce complications should be a high priority.

Cited by 10 publications

References 15 publications

Hospital-acquired conditions and length of stay in the pregnancy and puerperal cycle

Hospital-acquired conditions and length of stay in the pregnancy and puerperal cycle

“I just have to take it” – patient safety in acute care: perspectives and experiences of patients with chronic kidney disease

Activity‐based funding for safety and quality: A policy discussion of issues and directions for nursing‐focused health services outcomes research

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