Adverse events in hospitalised cancer patients: a comparison to a general hospital population

Haukland, Ellinor; Plessen, Christian von; Nieder, Carsten; Vonen, Barthold

doi:10.1080/0284186x.2017.1309063

Cited by 32 publications

(22 citation statements)

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“…Similar to other studies we find that medication harms and healthcare acquired infections were the most common adverse events [22,33], but their occurrences differed between the groups. While healthcare acquired infections contributed to death of cancer patients in both groups, anticancer treatment related adverse events, contributing to death only occurred in patients who received such treatment during the last 30 days of life.…”

Section: Discussionsupporting

confidence: 90%

“…This included all types of adverse events whether caused by systemic anticancer treatment, other medications or healthcare acquired infections. In a previous study we found that hospitalised cancer patients had an increased risk of adverse events in general compared to other hospitalised patients, and that they more often experienced adverse events related to medications [22].…”

Section: Discussionmentioning

confidence: 84%

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Adverse events in deceased hospitalised cancer patients as a measure of quality and safety in end-of-life cancer care

et al. 2020

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Background: Anticancer treatment exposes patients to negative consequences such as increased toxicity and decreased quality of life, and there are clear guidelines recommending limiting use of aggressive anticancer treatments for patients near end of life. The aim of this study is to investigate the association between anticancer treatment given during the last 30 days of life and adverse events contributing to death and elucidate how adverse events can be used as a measure of quality and safety in end-of-life cancer care. Methods: Retrospective cohort study of 247 deceased hospitalised cancer patients at three hospitals in Norway in 2012 and 2013. The Global Trigger Tool method were used to identify adverse events. We used Poisson regression and binary logistic regression to compare adverse events and association with use of anticancer treatment given during the last 30 days of life. Results: 30% of deceased hospitalised cancer patients received some kind of anticancer treatment during the last 30 days of life, mainly systemic anticancer treatment. These patients had 62% more adverse events compared to patients not being treated last 30 days, 39 vs. 24 adverse events per 1000 patient days (p < 0.001, OR 1.62 (1.23-2.15). They also had twice the odds of an adverse event contributing to death compared to patients without such treatment, 33 vs. 18% (p = 0.045, OR 1.85 (1.01-3.36)). Receiving follow up by specialist palliative care reduced the rate of AEs per 1000 patient days in both groups by 29% (p = 0.02, IRR 0.71, CI 95% 0.53-0.96). Conclusions: Anticancer treatment given during the last 30 days of life is associated with a significantly increased rate of adverse events and related mortality. Patients receiving specialist palliative care had significantly fewer adverse events, supporting recommendations of early integration of palliative care in a patient safety perspective.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 84%

Adverse events in deceased hospitalised cancer patients as a measure of quality and safety in end-of-life cancer care

et al. 2020

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“…Patients with cancer experience adverse events more frequently than other hospital patients. 1 Safety in healthcare is often described as a moving target and that numerous stakeholders are involved in keeping patients safe. 2 Families and next of kin are described as important safety experts but are rarely included in the patient's medical team.…”

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confidence: 99%

Resilience From a Stakeholder Perspective: The Role of Next of Kin in Cancer Care

2018

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Objective The aim of this article was to provide new knowledge on how next of kin are co-creators of resilient performance, as seen from the viewpoint of the healthcare personnel and managers. The following research question guided the study: How are next of kin involved in shaping resilience within cancer care in hospitals? Methods The design of the study is a case study of cancer departments in two Norwegian hospitals. Data collection included a total of 32 qualitative semistructured interviews at two organizational levels (managers and staff). The data were analyzed by ways of a directed content analysis according to Hollnagel's Resilience in Health Care framework of resilience potentials (anticipate, monitor, respond, learn). Results Next of kin are involved in creating and maintaining resilience in cancer care by different kind of activities and in-depth insight into the patient's condition, which strengthen all resilience potentials of responding, anticipation, monitoring, and learning. We have identified nine areas in which next of kin are co-creators in shaping resilience. Next of kin are important stakeholders, both as safety experts and as safety resources, helping healthcare professionals provide quality and safety in the patient care process under difficult conditions. Next of kin's knowledge of the patient's history, their observation of the patient over time within the hospital, at home, and across care transitions are key elements of their contribution. Conclusions Next of kin complement healthcare professionals in all four potentials for resilient performance. The study suggests that the Resilience in Health Care framework takes into account the role of next of kin, as a stakeholder potential, because this has not previously been sufficiently considered.

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“…Patients dying in the hospital are a highly selected group of patients who are older, stay longer, are mainly emergency admissions and have a smaller range of primary diagnoses. From a previous study, we know that the risk of adverse events increases by 1.3% for every year increase in age and 5.1% for each day spent in the hospital 21. To have a representative population, we argue that measuring adverse events contributing to death should be based on inpatient deaths rather than generalisation of reviews of general hospitalised patients.…”

Section: Discussionmentioning

confidence: 99%

Contribution of adverse events to death of hospitalised patients

et al. 2019

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BackgroundThere is no standardised method to investigate death as a patient safety indicator and we need valid and reliable measurements to use adverse events contributing to death as a quality measure.ObjectiveTo investigate the contribution of severe adverse events to death in hospitalised patients and clarify methodological differences using the Global Trigger Tool method on all inpatient deaths compared with a sample of general hospitalised patients.MethodRetrospective records reviewing using the Global Trigger Tool method.ResultsIn 0.3% of hospital admissions, adverse events contribute to inpatient death. Patients who die in hospital have twice the rate of adverse events per 1000 patient days compared with general patients, 76.7 vs 36.5 (p<0.001, RR 2.10, 95% CI 1.79 to 2.47). Patients dying in hospital experience seven times the rate of severe adverse events, 38.4% vs 5.2% (p<0.001, RR 2.10, 95% CI 1.79 to 2.47). For 86 out of 377 inpatient deaths, the adverse event is so severe that it contributes to death. 27.9% of severe adverse events contributing to death originate in primary care. Lower respiratory infections (p<0.001, RR 2.81, 95% CI 1.76 to 4.51), medication harm (p<0.001, RR 5.21, 95% CI 3.04 to 8.94) and pressure ulcers (p=0.04, RR 2.23, 95% CI 1.03 to 4.85) are significantly more frequent for inpatient deaths than in the general sample of hospital patients.ConclusionsPatients dying in hospitals experience seven times the rate of severe adverse events. Reviewing all inpatient death by the Global Trigger Tool method discloses new valid and reliable data of severe adverse events contributing to death which otherwise would be undetected.

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Adverse events in hospitalised cancer patients: a comparison to a general hospital population

Cited by 32 publications

References 18 publications

Adverse events in deceased hospitalised cancer patients as a measure of quality and safety in end-of-life cancer care

Adverse events in deceased hospitalised cancer patients as a measure of quality and safety in end-of-life cancer care

Resilience From a Stakeholder Perspective: The Role of Next of Kin in Cancer Care

Contribution of adverse events to death of hospitalised patients

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