The Impact of Medical Errors on Ninety‐Day Costs and Outcomes: An Examination of Surgical Patients

Encinosa, William; Hellinger, Fred J.

doi:10.1111/j.1475-6773.2008.00882.x

Cited by 101 publications

(85 citation statements)

References 21 publications

(25 reference statements)

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“…[19][20][21][22][23][24][25][26][27][28][29] To assess a dose-response relationship between an increasing number of instabilities and adverse outcomes, we used the Cochran-Armitage test for trend. We accounted for clustering of patients by hospital using generalized estimating equations.…”

Section: Resultsmentioning

confidence: 99%

Vital Signs Are Still Vital: Instability on Discharge and the Risk of Post-Discharge Adverse Outcomes

et al. 2016

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BACKGROUND: Vital sign instability on discharge could be a clinically objective means of assessing readiness and safety for discharge; however, the association between vital sign instability on discharge and post-hospital outcomes is unclear. OBJECTIVE: To assess the association between vital sign instability at hospital discharge and post-discharge adverse outcomes. DESIGN: Multi-center observational cohort study using electronic health record data. Abnormalities in temperature, heart rate, blood pressure, respiratory rate, and oxygen saturation were assessed within 24 hours of discharge. We used logistic regression adjusted for predictors of 30-day death and readmission. PARTICIPANTS: Adults (≥18 years) with a hospitalization to any medicine service in 2009-2010 at six hospitals (safety-net, community, teaching, and non-teaching) in north Texas. MAIN MEASURES: Death or non-elective readmission within 30 days after discharge. KEY RESULTS: Of 32,835 individuals, 18.7 % were discharged with one or more vital sign instabilities. Overall, 12.8 % of individuals with no instabilities on discharge died or were readmitted, compared to 16.9 % with one instability, 21.2 % with two instabilities, and 26.0 % with three or more instabilities (p < 0.001). The presence of any (≥1) instability was associated with higher risk-adjusted odds of either death or readmission (AOR 1.36, 95 % CI 1.26-1.48), and was more strongly associated with death (AOR 2.31, 95 % CI 1.91-2.79). Individuals with three or more instabilities had nearly fourfold increased odds of death (AOR 3.91, 95 % CI 1.69-9.06) and increased odds of 30-day readmission (AOR 1.36, 95 % 0.81-2.30) compared to individuals with no instabilities. Having two or more vital sign instabilities at discharge had a positive predictive value of 22 % and positive likelihood ratio of 1.8 for 30-day death or readmission. CONCLUSIONS: Vital sign instability on discharge is associated with increased risk-adjusted rates of 30-day mortality and readmission. These simple vital sign criteria could be used to assess safety for discharge, and to reduce 30-day mortality and readmissions.

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Section: Resultsmentioning

confidence: 99%

Vital Signs Are Still Vital: Instability on Discharge and the Risk of Post-Discharge Adverse Outcomes

et al. 2016

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“…They found an average SSI-attributable increase in hospital stays of 9.7 days, with the highest occurring for cardiovascular SSIs (13.7 days). The study that is closest to ours in research question, data, and design was published by Encinosa and Hellinger (2008) using information from enrollees in a large private insurance database. These authors examined claims payments for the index hospitalization and a 90-day follow period for 4,140 patients with PSIs, assigning 1:1 propensity-matched controls.…”

Section: Recent Literaturementioning

confidence: 99%

The Impact of Hospital-Acquired Conditions on Medicare Program Payments

Kandilov

Coomer

Dalton

2014

MMRR

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“…Thus, while a few studies have examined the impact of EMRs on patient safety rates, no studies have yet to examine the impact of EMRs on patient safety costs and outcomes. In this study, we address this limitation and extend the seminal patient safety study by Encinosa and Hellinger (2008) on patient safety costs and outcomes by merging EMR data from the American Hospital Association (AHA) to national insurance claims data. We examine not only whether EMRs prevent a wide spectrum of HACs, but also examine whether EMRs prevent death, readmissions, and high spending over the course of 90 days following occurrence of a HAC.…”

mentioning

confidence: 99%

Health Information Technology and its Effects on Hospital Costs, Outcomes, and Patient Safety

Encinosa

Bae²

2011

INQUIRY

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Underlying many reforms in the Patient Protection and Affordable Care Act (ACA) is the use of electronic medical records (EMRs) to help contain costs. We use MarketScan® claims data and American Hospital Association information technology (IT) data to examine whether EMRs can contain costs in the ACA's reforms to reduce patient safety events. We find EMRs do not reduce the rate of patient safety events. However, once an event occurs, EMRs reduce death by 34%, readmissions by 39%, and spending by $4,850 (16%), a cost offset of $1.75 per $1 spent on IT capital. Thus, EMRs contain costs by better coordinating care to rescue patients from medical errors once they occur.

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The Impact of Medical Errors on Ninety‐Day Costs and Outcomes: An Examination of Surgical Patients

Abstract: The effects of medical errors continue long after the patient leaves the hospital. Medical error studies that focus only on the inpatient stay can underestimate the impact of patient safety events by up to 20-30 percent.

Cited by 101 publications

References 21 publications

Vital Signs Are Still Vital: Instability on Discharge and the Risk of Post-Discharge Adverse Outcomes

Vital Signs Are Still Vital: Instability on Discharge and the Risk of Post-Discharge Adverse Outcomes

The Impact of Hospital-Acquired Conditions on Medicare Program Payments

Health Information Technology and its Effects on Hospital Costs, Outcomes, and Patient Safety

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