Impact of Inpatient Harms on Hospital Finances and Patient Clinical Outcomes

Adler, Lee; Yi, David; Li, Michael; McBroom, Barry; Hauck, Loran D.; Sammer, Christine; Jones, Cason; Shaw, Terry V.; Classen, David C.

doi:10.1097/pts.0000000000000171

Cited by 61 publications

(59 citation statements)

References 29 publications

(22 reference statements)

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“…However, our primary relationship of interest between delirium and death would not be expected to be different today, as no interventions have been shown to reduce mortality from delirium . In addition, the CAM remains the tool of choice to identify delirium, and the adverse hospital exposures examined in our study continue to occur at sub‐optimally high rates . Secondly, we cannot eliminate all sources of bias influencing the relationship of delirium with death.…”

Section: Discussionmentioning

confidence: 96%

“…These events can result in significant harm and have therefore become an increasing focus for quality improvement . Yet these adverse exposures still occur at unacceptably high rates to hospitalized patients . If commonly associated with the pathway from delirium to death, restraining devices, HACs, and other noxious insults during hospitalization can serve as specific targets for quality improvement in patients with delirium.…”

mentioning

confidence: 99%

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Pathway from Delirium to Death: Potential In‐Hospital Mediators of Excess Mortality

Dharmarajan

Swami

Gou

et al. 2016

J American Geriatrics Society

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OBJECTIVES (1) To determine the relationship of incident delirium during hospitalization with 90-day mortality; (2) to identify potential in-hospital mediators through which delirium increases 90-day mortality. DESIGN Analysis of data from Project Recovery, a controlled clinical trial of a delirium prevention intervention from 1995 to 1998 with follow-up through 2000. SETTING Large academic hospital. PARTICIPANTS Patients ≥70 years-old without delirium at hospital admission who were at intermediate-to-high risk of developing delirium and received usual care only. MEASUREMENTS (1) Incident delirium; (2) potential mediators of delirium on death including use of restraining devices (physical restraints, urinary catheters), development of hospital acquired conditions (HACs) (falls, pressure ulcers), and exposure to other noxious insults (sleep deprivation, acute malnutrition, dehydration, aspiration pneumonia); (3) death within 90 days of admission. RESULTS Among 469 patients, 70 (15%) developed incident delirium. These patients were more likely to experience restraining devices (37% vs. 16%, p<.001), HACs (37% vs. 12%, p<.001), other noxious insults (63% vs. 49%, p=.03), and 90-day mortality (24% vs. 6%, p<.001). The inverse probability weighted hazard of death due to delirium was 4.2 (95% CI=2.8–6.3) in bivariable analyses, increased in a graded manner with additional exposures to restraining devices, HACs, and other noxious insults, and declined by 10.9% after addition of these potential mediator categories, providing evidence of mediation. CONCLUSION Restraining devices, HACs, and additional noxious insults were more frequent among patients with delirium, increased mortality in a graded manner, and were responsible for a significant percentage of the association of delirium with death. Additional efforts to prevent potential downstream mediators through which delirium increases mortality may help to improve outcomes among hospitalized older adults.

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Section: Discussionmentioning

confidence: 96%

mentioning

confidence: 99%

Pathway from Delirium to Death: Potential In‐Hospital Mediators of Excess Mortality

Dharmarajan

Swami

Gou

et al. 2016

J American Geriatrics Society

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“…Studies indicate that a patient harmed as a result of an adverse event is 3.2 times more likely to die, to have an 8‐day length of stay, and to cause additional costs of nearly $10 000 per case (Adler et al. ). Future studies could focus on the improvement of the EPEA so that it can be used in nursing management as a preventive detection mechanism for adverse events, as well as for the development of new clinical safety protocols.…”

Section: Discussionmentioning

confidence: 99%

“…Adverse events, understood as unintended injuries or complications resulting from the provision of health care (Baker et al 2004;Stang et al 2013), have a very significant impact on patient outcomes, burnout and health costs. Studies indicate that a patient harmed as a result of an adverse event is 3.2 times more likely to die, to have an 8-day length of stay, and to cause additional costs of nearly $10 000 per case (Adler et al 2018). Future studies could focus on the improvement of the EPEA so that it can be used in nursing management as a preventive detection mechanism for adverse events, as well as for the development of new clinical safety protocols.…”

Section: Instrumentsmentioning

confidence: 99%

Evaluation of psychometric properties of instruments measuring nursing‐sensitive outcomes: a systematic review

Barrientos‐Trigo

Gil‐García

Romero‐Sánchez

et al. 2018

International Nursing Review

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Aim To evaluate the psychometric properties of instruments measuring Nursing‐sensitive Outcomes in acute care hospitals. Introduction Nursing‐sensitive outcomes have been shown to play an active role in the quality of care and cost‐effectiveness of health systems. Tools for assessing nursing‐sensitive outcomes are necessary to evaluate the nurses’ contributions to the health of patients. Methods Psychometric systematic review. The SCOPUS, PubMed, CINAHL, PsychoINFO, EMBASE, Science Direct and Web of Science databases were used. Searches were performed between March and May 2018. A search with screened titles and abstracts, assessment of methodological quality using the COSMIN checklist and risk of bias assessment using QUADAS‐2 were carried out. Results Twenty‐nine studies validated 26 different instruments. The methodological quality, measured with the COSMIN checklist, showed that the studies which assessed fewer psychometric properties had poorer quality. The majority of studies had high quality, and optimally assessed the risk of bias evaluated with QUADAS‐2. Discussion Concerning the focus of the scales, some of them focused on the patients while others focused on the nursing staff. The scales found assessed aspects such as nursing‐care quality, complexity and personalization. Conclusion The majority of studies had a high methodological strength and a thorough validation process. The Nurse Caring Behaviours Scale, the MISSCARE Survey, the Patient Advocacy Engagement Scale and the INICIARE scale were the tools which best combined structure, methodological quality and risk of bias. Implications for nursing and health policy The instruments with the best psychometric properties should be implemented in acute care settings to improve the quality of care, assess the effectiveness of nursing interventions, reduce health expenditure and reduce the occurrence of adverse events.

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“…Jha and colleagues estimated 42.7 million adverse events occur in the 421 million annual hospitalizations worldwide, resulting in 23 million lost disability‐adjusted life years in primarily low‐ and middle‐income countries (Jha et al., ). Aside from the human costs in terms of morbidity and mortality, adverse events are costly to healthcare systems (Adler et al., ; Van Den Bos et al., ).…”

Section: Introductionmentioning

confidence: 99%

Priming patient safety: A middle‐range theory of safety goal priming via safety culture communication

Groves

Bunch

2018

Nursing Inquiry

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The aim of this paper is discussion of a new middle-range theory of patient safety goal priming via safety culture communication. Bedside nurses are key to safe care, but there is little theory about how organizations can influence nursing behavior through safety culture to improve patient safety outcomes. We theorize patient safety goal priming via safety culture communication may support organizations in this endeavor. According to this theory, hospital safety culture communication activates a previously held patient safety goal and increases the perceived value of actions nurses can take to achieve that goal. Nurses subsequently prioritize and are motivated to perform tasks and risk assessment related to achieving patient safety. These efforts continue until nurses mitigate or ameliorate identified risks and hazards during the patient care encounter. Critically, this process requires nurses to have a previously held safety goal associated with a repertoire of appropriate actions. This theory suggests undergraduate educators should foster an outcomes focus emphasizing the connections between nursing interventions and safety outcomes, hospitals should strategically structure patient safety primes into communicative activities, and organizations should support professional development including new skills and the latest evidence supporting nursing practice for patient safety.

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Impact of Inpatient Harms on Hospital Finances and Patient Clinical Outcomes

Abstract: Supplemental digital content is available in the text.

Cited by 61 publications

References 29 publications

Pathway from Delirium to Death: Potential In‐Hospital Mediators of Excess Mortality

Pathway from Delirium to Death: Potential In‐Hospital Mediators of Excess Mortality

Evaluation of psychometric properties of instruments measuring nursing‐sensitive outcomes: a systematic review

Priming patient safety: A middle‐range theory of safety goal priming via safety culture communication

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