Directeur Nivel; projectleider Patiëntveiligheid; hoogleraar 'Patiëntveiligheid', Vrije Universiteit / Amsterdam UMC
Publicatie
Differences in the occurence of adverse events between discharged or deceased patients in Dutch hospitals.
Zegers, M., Bruyne, M.C. de, Wagner, C., Groenewegen, P.P., Wal, G. van der. Differences in the occurence of adverse events between discharged or deceased patients in Dutch hospitals. In: Book of abstracts. International Conference 'Patient Safety Research shaping the European Agenda', 24-26 september 2007, Porto. 160
ABSTRACT:
Introduction
Various international studies revealed that 2.9% to 16.6% of patients in acute care hospitals experienced one or more adverse events and that in 5% to 13% of the adverse events patients died. Approximately 50% of the adverse events were considered as preventable. Previous studies showed that the occurrence of adverse events among deceased patients is twice as high than the occurrence of adverse events among discharged patients. So it is more efficient to identify adverse events among deceased patients to study and monitoring patient safety, if deceased patients have similar adverse events compared with discharged patients. Therefore, as part of the Dutch Patient Safety Research Program, an epidemiological study was initiated to (1) determine the incidence, nature, type, impact, causes, and preventability among discharged or deceased patients, (2) examine the differences of patient and admission characteristics between deceased or discharged hospitalised patients with adverse events; and (3) study the differences of patient and admission characteristics between deceased patients with an adverse event that contributed to the death of patients and deceased patients with an adverse event that did not contributed to the death of patients.
Methods
The study is a three-stage retrospective patient record study in which 7926 patient records of discharged or deceased patients in 2004 in 21 hospitals were reviewed. The records of randomly selected admissions were
reviwed by nurses and physicians between August 2005 and 0ctober 2006. To examine the difference of patient and admission characteristics between discharged and deceased patients, we over sampled admissions of deceased patients. The records of the sampled admissions were reviewed to identify adverse events, degree of preventability, impact, nature, type and causes of adverse events. In addition, patient demographics such as age, sex, and comorbidity and admission characteristics like discharge diagnosis, admission department, admission status (elective, urgent), and discharge status (dead, alive) were identified. The primary outcomes of this study were the occurrence of adverse events among deceased and discharged patients, the differences of patient and admission characteristics between the two patient groups, and whether adverse events among deceased patients contributed to the death of patients. Multi-level regression analysis was used because the data had an hierarchical structure; the patient records (level 1) are nested in the sample of hospita! departments (level 2), which are nested in the hospitals (level 3).
Discussion
The results of our study are still confidential. They will be presented at a Dutch conference in April 2007. Preliminary results show that deceased patients with an adverse event were older, had a longer admission duration, had more co-morbidity, and more often had an acute admission compared with discharged patients with an adverse event. Also deceased patients with an adverse event have twice as much diagnostic related adverse events and adverse events were mostly related to non-surgical departments. Adverse events among deceased patients were more often preventable. Two third (70%) of adverse events among deceased patients had contributed to the death of patients. These adverse events were more often preventable and were most related to surgical departments; adverse events not contributed to the death of patients were more often not preventable and were most related to nonsurgical departments. Studies that only focus on deceased patients to identify determinants of adverse events must be aware of the fact that the results can not be extrapolated to all hospitalized patients. Deceased patients with adverse events have different patient and admission characteristics compared with discharged patients with adverse events. Also patients with adverse events that contributed to the death of the patient different from patients with adverse events that did not contribute to the death of patients.
Introduction
Various international studies revealed that 2.9% to 16.6% of patients in acute care hospitals experienced one or more adverse events and that in 5% to 13% of the adverse events patients died. Approximately 50% of the adverse events were considered as preventable. Previous studies showed that the occurrence of adverse events among deceased patients is twice as high than the occurrence of adverse events among discharged patients. So it is more efficient to identify adverse events among deceased patients to study and monitoring patient safety, if deceased patients have similar adverse events compared with discharged patients. Therefore, as part of the Dutch Patient Safety Research Program, an epidemiological study was initiated to (1) determine the incidence, nature, type, impact, causes, and preventability among discharged or deceased patients, (2) examine the differences of patient and admission characteristics between deceased or discharged hospitalised patients with adverse events; and (3) study the differences of patient and admission characteristics between deceased patients with an adverse event that contributed to the death of patients and deceased patients with an adverse event that did not contributed to the death of patients.
Methods
The study is a three-stage retrospective patient record study in which 7926 patient records of discharged or deceased patients in 2004 in 21 hospitals were reviewed. The records of randomly selected admissions were
reviwed by nurses and physicians between August 2005 and 0ctober 2006. To examine the difference of patient and admission characteristics between discharged and deceased patients, we over sampled admissions of deceased patients. The records of the sampled admissions were reviewed to identify adverse events, degree of preventability, impact, nature, type and causes of adverse events. In addition, patient demographics such as age, sex, and comorbidity and admission characteristics like discharge diagnosis, admission department, admission status (elective, urgent), and discharge status (dead, alive) were identified. The primary outcomes of this study were the occurrence of adverse events among deceased and discharged patients, the differences of patient and admission characteristics between the two patient groups, and whether adverse events among deceased patients contributed to the death of patients. Multi-level regression analysis was used because the data had an hierarchical structure; the patient records (level 1) are nested in the sample of hospita! departments (level 2), which are nested in the hospitals (level 3).
Discussion
The results of our study are still confidential. They will be presented at a Dutch conference in April 2007. Preliminary results show that deceased patients with an adverse event were older, had a longer admission duration, had more co-morbidity, and more often had an acute admission compared with discharged patients with an adverse event. Also deceased patients with an adverse event have twice as much diagnostic related adverse events and adverse events were mostly related to non-surgical departments. Adverse events among deceased patients were more often preventable. Two third (70%) of adverse events among deceased patients had contributed to the death of patients. These adverse events were more often preventable and were most related to surgical departments; adverse events not contributed to the death of patients were more often not preventable and were most related to nonsurgical departments. Studies that only focus on deceased patients to identify determinants of adverse events must be aware of the fact that the results can not be extrapolated to all hospitalized patients. Deceased patients with adverse events have different patient and admission characteristics compared with discharged patients with adverse events. Also patients with adverse events that contributed to the death of the patient different from patients with adverse events that did not contribute to the death of patients.
ABSTRACT:
Introduction
Various international studies revealed that 2.9% to 16.6% of patients in acute care hospitals experienced one or more adverse events and that in 5% to 13% of the adverse events patients died. Approximately 50% of the adverse events were considered as preventable. Previous studies showed that the occurrence of adverse events among deceased patients is twice as high than the occurrence of adverse events among discharged patients. So it is more efficient to identify adverse events among deceased patients to study and monitoring patient safety, if deceased patients have similar adverse events compared with discharged patients. Therefore, as part of the Dutch Patient Safety Research Program, an epidemiological study was initiated to (1) determine the incidence, nature, type, impact, causes, and preventability among discharged or deceased patients, (2) examine the differences of patient and admission characteristics between deceased or discharged hospitalised patients with adverse events; and (3) study the differences of patient and admission characteristics between deceased patients with an adverse event that contributed to the death of patients and deceased patients with an adverse event that did not contributed to the death of patients.
Methods
The study is a three-stage retrospective patient record study in which 7926 patient records of discharged or deceased patients in 2004 in 21 hospitals were reviewed. The records of randomly selected admissions were
reviwed by nurses and physicians between August 2005 and 0ctober 2006. To examine the difference of patient and admission characteristics between discharged and deceased patients, we over sampled admissions of deceased patients. The records of the sampled admissions were reviewed to identify adverse events, degree of preventability, impact, nature, type and causes of adverse events. In addition, patient demographics such as age, sex, and comorbidity and admission characteristics like discharge diagnosis, admission department, admission status (elective, urgent), and discharge status (dead, alive) were identified. The primary outcomes of this study were the occurrence of adverse events among deceased and discharged patients, the differences of patient and admission characteristics between the two patient groups, and whether adverse events among deceased patients contributed to the death of patients. Multi-level regression analysis was used because the data had an hierarchical structure; the patient records (level 1) are nested in the sample of hospita! departments (level 2), which are nested in the hospitals (level 3).
Discussion
The results of our study are still confidential. They will be presented at a Dutch conference in April 2007. Preliminary results show that deceased patients with an adverse event were older, had a longer admission duration, had more co-morbidity, and more often had an acute admission compared with discharged patients with an adverse event. Also deceased patients with an adverse event have twice as much diagnostic related adverse events and adverse events were mostly related to non-surgical departments. Adverse events among deceased patients were more often preventable. Two third (70%) of adverse events among deceased patients had contributed to the death of patients. These adverse events were more often preventable and were most related to surgical departments; adverse events not contributed to the death of patients were more often not preventable and were most related to nonsurgical departments. Studies that only focus on deceased patients to identify determinants of adverse events must be aware of the fact that the results can not be extrapolated to all hospitalized patients. Deceased patients with adverse events have different patient and admission characteristics compared with discharged patients with adverse events. Also patients with adverse events that contributed to the death of the patient different from patients with adverse events that did not contribute to the death of patients.
Introduction
Various international studies revealed that 2.9% to 16.6% of patients in acute care hospitals experienced one or more adverse events and that in 5% to 13% of the adverse events patients died. Approximately 50% of the adverse events were considered as preventable. Previous studies showed that the occurrence of adverse events among deceased patients is twice as high than the occurrence of adverse events among discharged patients. So it is more efficient to identify adverse events among deceased patients to study and monitoring patient safety, if deceased patients have similar adverse events compared with discharged patients. Therefore, as part of the Dutch Patient Safety Research Program, an epidemiological study was initiated to (1) determine the incidence, nature, type, impact, causes, and preventability among discharged or deceased patients, (2) examine the differences of patient and admission characteristics between deceased or discharged hospitalised patients with adverse events; and (3) study the differences of patient and admission characteristics between deceased patients with an adverse event that contributed to the death of patients and deceased patients with an adverse event that did not contributed to the death of patients.
Methods
The study is a three-stage retrospective patient record study in which 7926 patient records of discharged or deceased patients in 2004 in 21 hospitals were reviewed. The records of randomly selected admissions were
reviwed by nurses and physicians between August 2005 and 0ctober 2006. To examine the difference of patient and admission characteristics between discharged and deceased patients, we over sampled admissions of deceased patients. The records of the sampled admissions were reviewed to identify adverse events, degree of preventability, impact, nature, type and causes of adverse events. In addition, patient demographics such as age, sex, and comorbidity and admission characteristics like discharge diagnosis, admission department, admission status (elective, urgent), and discharge status (dead, alive) were identified. The primary outcomes of this study were the occurrence of adverse events among deceased and discharged patients, the differences of patient and admission characteristics between the two patient groups, and whether adverse events among deceased patients contributed to the death of patients. Multi-level regression analysis was used because the data had an hierarchical structure; the patient records (level 1) are nested in the sample of hospita! departments (level 2), which are nested in the hospitals (level 3).
Discussion
The results of our study are still confidential. They will be presented at a Dutch conference in April 2007. Preliminary results show that deceased patients with an adverse event were older, had a longer admission duration, had more co-morbidity, and more often had an acute admission compared with discharged patients with an adverse event. Also deceased patients with an adverse event have twice as much diagnostic related adverse events and adverse events were mostly related to non-surgical departments. Adverse events among deceased patients were more often preventable. Two third (70%) of adverse events among deceased patients had contributed to the death of patients. These adverse events were more often preventable and were most related to surgical departments; adverse events not contributed to the death of patients were more often not preventable and were most related to nonsurgical departments. Studies that only focus on deceased patients to identify determinants of adverse events must be aware of the fact that the results can not be extrapolated to all hospitalized patients. Deceased patients with adverse events have different patient and admission characteristics compared with discharged patients with adverse events. Also patients with adverse events that contributed to the death of the patient different from patients with adverse events that did not contribute to the death of patients.
