The incidence and nature of adverse events in rehabilitation inpatients with acquired brain injuries

Abstract

Background: Patient safety is important in all healthcare settings. Few studies have examined the state of patient safety in rehabilitation and none have examined patient safety in the setting of acquired brain injury (ABI) rehabilitation. Objectives: To determine the incidence, most common types, and severities of adverse events among inpatients undergoing ABI rehabilitation. Design: Retrospective case series descriptive study. Setting: The inpatient ABI rehabilitation program at an academic, tertiary rehabilitation hospital in Canada. Participants: One hundred eight consecutive inpatients with acquired brain injuries. Interventions: Not applicable. Main Outcome Measures: Patient charts and incident reports from the hospital's voluntary reporting system were reviewed by three board-certified physiatrists to determine the incidence, type, severity and preventability of adverse events. Adverse events were identified and classified for severity and type using the World Health Organization (WHO) International Classification for Patient Safety. Preventability was rated on a six-point Likert scale. Results: During the study period, the incidence of adverse events was 17.42 AE 3.86 per 1000 patient days. Adverse events affected 52.8% of patients. Most adverse events identified were mild in severity (81.6%) and the rest were of moderate severity. The two most common types of adverse events were (1) patient incidents (50%) such as falls, pressure ulcers and skin tears and (2) patient behaviors such as missing patient, assault, or sexual behaviors (14.5%). Of the 76 adverse events identified in the study, 44.8% were preventable. The hospital's voluntary reporting system did not capture 57.9% of the adverse events identified. Conclusions: Future efforts to improve patient safety in ABI rehabilitation should focus on reducing falls, skin injuries and behaviors, and removing barriers to voluntary incident reporting. Detection of adverse events through chart reviews provides a more complete understanding of patient safety risks in ABI rehab than relying on incident reporting alone.

Investigating the Prevalence, Severity, and Nature of Adverse Events in an Inpatient Rehabilitation Hospital

“…According to the results from previous studies, between 17.42% to 29% of patients in rehabilitation hospitals experience AEs [5,10]. Both significant data on critical aspects of hospital performance and impetus for the development of patient safety programs are provided in these studies [7].…”

“…The first step toward improving PS is to obtain accurate data on PS. The current PS status must be assessed by acquiring data, such as the incidence, common types, severities, and preventability of AEs to determine how to take steps toward improving PS [5].…”

“…There are differences between inpatient rehabilitation hospitals and acute care settings in terms of care objectives and patient groups [5]. The complexity of care in a rehabilitation hospital may increase the risk of AEs related to the lack of communication and coordination of care because of service delivery by different provider groups and the higher involvement of non-nurse healthcare providers, patients, and patients' family members [6,7].…”

“…Moreover, clients in inpatient rehabilitation hospitals are usually patients with different disabilities and problems, such as traumatic or non-traumatic head and spinal injuries, stroke, amputation, weakness, disability, joint replacement, cognitive and memory impairments, walking disorders, swallowing problems, and functional disorders [8,9]. These characteristics put clients at a greater risk of PS events [8,9], such as falls, pressure ulcers, wound infection, documentation errors, ineffective communication, intentional harm, abuse, and infections [5,8].…”

“…The literature has highlighted the issues of reporting AEs in acute care settings but few studies have examined the frequency and consequences of AEs, in addition to factors that predict their occurrence in the IRHs [5,9]. For example, a retrospective study in a rehabilitation hospital in Canada showed that the most prevalent AEs for patients with acquired brain injuries were falls, pressure ulcers, and bedsores (56.72%), as well as patient negligence, assault, and sexual abuse (16.42%) [5]. Another retrospective cross-sectional study examined the types of AEs associated with rehabilitation therapies in 9 years in rehabilitation hospitals in the United States.…”