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Patient safety risks and patients treated by multiple specialties.

Baines, R., Bruijne, M. de, Langelaan, M., Wagner, C. Patient safety risks and patients treated by multiple specialties.: , 2013. 1454 p. Abstract. In: Abstractbook 5 Minute presentations. International Society for Quality in Health Care (ISQUA) 30th International Conference 'Quality and safety in population health and healthcare'. Edinburgh: ISQUA, 2013.
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Objectives: To determine if the number of medical specialties treating a patient is associated with
the risk of experiencing harm during hospital admission. Methods: We performed structured retrospective patient record review study by trained nurses and physicians. We included 20 hospitals in the Netherlands. In each hospital 200 patient admissions from 2008 were included, only admissions to the psychiatry department, obstetrics and children under one year were excluded. The nursing, medical and, if available, outpatient records of the sampled patient admissions were reviewed by trained external nurses and physicians. During the review process additional data was gathered on the number of specialties involved in the treatment of the patient during the sample-admission. The nurses were asked to score which specialties were involved in the treatment of the patient. Based on a standardized procedure and preceded by a number of underlying questions to secure a systematic assessment, the presence and preventability of an AE was determined by the physicians. Reviewers assessed preventability of the AE by judging if suboptimal care had played a role, i.e. if the care given fell below the current level of expected performance for practitioners or systems. If an AE was identified, a variety of questions about the AE were asked, such as the clinical processes and causes related to the AE. Association between preventable and non-preventable AEs and the number of specialties treating a patient was determined by stepwise multilevel regression analysis (MLwin 2.22). To explain underlying mechanisms of possible risk differences, we further assessed differences in suboptimal care, causes related to the AEs and clinical processes. Results: The number of specialties is associated with the risk of experiencing adverse events. Patients treated by three or more specialties had an OR of 2.82 (95% CI 2.03 to 3.93) for experiencing non-preventable adverse events (reference group one specialty), and an OR of 2.42 (95% CI 1.66 to 3.52) for preventable adverse events. After adding patient and health care related characteristics the OR for non-preventable AE decreased to 1.46 (95% CI 0.99 to 2,14), for preventable adverse events to 1.91 (95% CI 1.23 to 2.97). Thus after corrections for patient and health care characteristics the increased risk on harm for patients treated by multiple specialties stayed most visible in preventable AEs. Analysis of causes of AEs did not show differences between the different groups of involved specialties or between preventable AEs and non-preventable AEs. Analysis of related clinical processes showed that especially in patients treated by three or more specialties more preventable AEs related to diagnostic processes were found in comparison with admissions with one specialty. More preventable AEs related to surgical processes were found in patients with one involved specialty than in patients with more specialties. Conclusion: In conclusion the number of specialties treating a patients is associated with a the risk of experiencing preventable AEs. Our data may indicate a higher risk of suboptimal care with an increasing number of specialties, but we can not ensure a causal relationship. We hope that this study brings awareness to the fact that patients treated by multiple specialties have a higher risk of experiencing preventable adverse events. When health care organisations and health care workers are conscious of this fact, they can also anticipate on methods to prevent extra harm to this patient group, as changes to the organisation structure, improved communication methods and methods to heighten the situational awareness and teamwork.