What makes hospitalized patients more vulnerable and increases their risk of experiencing an adverse event?

Andrés, Jesús María Aranaz; Limón, Ramón; Mira, José Joaquín; Aibar, Carlos; Gea, María Teresa; Varela, Yolanda Agra

doi:10.1093/intqhc/mzr059

Cited by 48 publications

(40 citation statements)

References 21 publications

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“…Similar findings using similar methodology were generated from the Spanish study of AEs, the conclusion drawn being that the true risk of AEs depends on the number of exposures to potentially iatrogenic actions rather than age or the presence of comorbidities. 76 We would concur with previous national studies that comorbidity in itself does not play a significant role in increasing an individual's risk of experiencing an AE. There are interactions, however, that remain to be explored, and increased risk is evident in patients who have heightened vulnerability as a result of physical or cognitive decline.…”

Section: Summary Of Findings Discussion and Conclusionsupporting

confidence: 89%

Measuring harm and informing quality improvement in the Welsh NHS: the longitudinal Welsh national adverse events study

Mayor

Baines

Vincent

et al. 2017

Health Serv Deliv Res

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Background, objectives and settingDespite global activity over the past 15 years to improve patient safety, the measurement of adverse events (AEs) remains challenging.ObjectivesWe aimed to obtain definitive longitudinal data on harm across NHS Wales and to compare the performance of the Global Trigger Tool (GTT) with the two-stage retrospective review process, using our findings to consolidate an approach to the ongoing surveillance of harm in Wales.Data sourcesEleven of the 13 major Welsh NHS hospitals.Review methodsThe two-stage retrospective review methodology was used to quantify harm across NHS Wales. In total, 4536 inpatient episodes were screened for AEs by research nurses. Records that were highly suggestive of AEs were further assessed by physicians. NHS-led teams undertook GTT reviews on the same case notes.ResultsAt least one AE was determined in 10.3% of episodes of care [95% confidence interval (CI) 9.4% to 11.2%] and 51.5% were preventable (95% CI 46.9% to 56.1%). The percentage of patients identified with AEs using the GTT methodology was lower, at 9.0% (95% CI 8.82% to 9.18%). Differences in AEs were evident across study sites. Methods were developed to profile the risk of AEs in individual organisations by producing signatures of harm for each NHS site. Analysis indicated that neither the GTT nor the two-stage process was a candidate tool for routine surveillance, and a hybrid one-stage tool (Harm2), based on phase 1 findings, was developed for ongoing AE monitoring. Using the Harm2 tool, AEs were identified in 371 out of 3352 randomly selected discharge reviews (11.3%, 95% CI 10.2% to 12.4%), and 59.6% (95% CI 55.3 to 63.9) of these were preventable. In a cohort of randomly selected deceased patient reviews, at least one AE was determined in 315 out of 1018 admissions (30.1%, 95% CI 28.1% to 33.8%), and 61.7% (95% CI 57.5% to 65.9%) of these were preventable. Factors associated with AEs in the randomly selected discharge reviews included having peripheral vascular disease [odds ratio (OR) 2.52], hemiplegia (OR 2.27) or dementia (OR 2.27). No association with chronic disease was identified in the deceased episodes of care.LimitationsThe dependence on our health service partners in identifying notes to be reviewed, along with the small sample examined each month, limits the generalisability of these findings and rates were not standardised for hospital and size and level of services provided. We cannot rule out the possibility that the rates we report may be underestimated.ConclusionThe extent of harm detected across NHS Wales using both the two-stage retrospective review process and the new Harm2 tool conforms to the findings in the literature, but this is the first longitudinal study using these methods. With training and using a structured review process, non-physician reviewers can undertake case note review efficiently and effectively, and the rates of AEs and of the preventability and the breakdown of problems in care conform to those reported in studies in which physicians undertake these classifications. Whether the patient died or was discharged alive significantly influences the rate and composition of AEs. The Harm2 tool performed with moderate reliability in the determination of AEs.Future workFuture large-scale studies should attempt to specify types of AEs, such as hospital-acquired infections and surgical complications, to enable the surveillance of the specific types of harm as well as the overall level of AEs. In the longer term, we need to automate harm surveillance and set measures of harm alongside measures of the beneficial effects of health care.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Summary Of Findings Discussion and Conclusionsupporting

confidence: 89%

Measuring harm and informing quality improvement in the Welsh NHS: the longitudinal Welsh national adverse events study

Mayor

Baines

Vincent

et al. 2017

Health Serv Deliv Res

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“…For that purpose, analysing the details of patients with ADEs alone is not enough, the information of patients who have not experienced ADEs is also needed (Aranaz‐Andrés et al . ). Previous studies have used various methods for identifying patient‐specific risk factors.…”

Section: Introductionmentioning

confidence: 97%

Patient‐specific risk factors of adverse drug events in adult inpatients – evidence detected using the Global Trigger Tool method

Härkänen

Kervinen

Ahonen

et al. 2014

Journal of Clinical Nursing

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“…Estudos realizaram uma comparação das taxas de incidência de EA entre os pacientes adultos e idosos hospitalizados, o que demonstra que estes últimos experimentam mais destes incidentes do que os pacientes mais jovens, com consequências mais graves, estando a maioria desses sujeitos suscetível nas enfermarias de clínica médica (12)(13)(14)(15) .…”

Section: Eventos Adversos Em Clientes Idosos Hospitalizadosunclassified

“…Os fatores que contribuem significativamente para o aumento dos riscos de eventos adversos na prestação do cuidado ao idoso são: redução da capacidade funcional, presença de comorbidades e doenças graves, utilização de dispositivos invasivos, tempo prolongado de internação hospitalar e cuidados inadequados (12,16) . Quanto aos tipos de eventos adversos evitáveis em idosos internados, são citados aqueles que variam desde síndromes geriátricas como delirium, úlceras de pressão (UPP), incontinência urinária ou fecal, associados a medicamentos (EAM), infecção hospitalar e complicações relacionadas aos procedimentos.…”

Section: Eventos Adversos Em Clientes Idosos Hospitalizadosunclassified

Segurança Do Paciente Idoso Hospitalizado: Uma Revisão Integrativa

et al. 2016

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SAFETY OF HOSPITALIZED ELDERLY PATIENTS: AN INTEGRATIVE LITERATURE REVIEW ABSTRACT:The objective was to identify how the safety of hospitalized elderly patients has been discussed in the scientific literature. An integrative literature review was undertaken in the databases Literatura Latino Americana e do Caribe em Ciências da Saúde, Scientific Electronic Library Online, Medical Literature Analysis and Retrieval System and U.S. National Library of Medicine, published between 2009 and 2015. The 25 selected publications discuss the importance of promoting affective care in the reduction of insecurity and adverse events in hospitalized elderly, besides the challenges for the implementation of a safe and high-quality environment for these patients. Gaps were found in the knowledge on this theme. Further studies are needed that focus on the description of a dimensioned and suitable environment and on the elaboration and implementation of care quality safety and improvement programs for elderly patients while in hospital. Los 25 seleccionados discuten la importancia de promover el cuidado afectivo en la reducción de la inseguridad y de los eventos adversos en ancianos hospitalizados, además de los retos a la implementación de ambiente seguro y de cualidad para este paciente. Fueron constatadas brechas en el conocimiento sobre este tema, siendo necesarios otros estudios con foco en la descripción de ambiente dimensionado y adecuado, elaboración e implementación de programas para seguridad y mejora de la calidad del cuidado al anciano durante la hospitalización.

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What makes hospitalized patients more vulnerable and increases their risk of experiencing an adverse event?

Abstract: The true risk resides in the number of exposures to potentially iatrogenic actions, rather than being intrinsic to age or the presence of certain comorbidities.

Cited by 48 publications

References 21 publications

Measuring harm and informing quality improvement in the Welsh NHS: the longitudinal Welsh national adverse events study

Measuring harm and informing quality improvement in the Welsh NHS: the longitudinal Welsh national adverse events study

Patient‐specific risk factors of adverse drug events in adult inpatients – evidence detected using the Global Trigger Tool method

Segurança Do Paciente Idoso Hospitalizado: Uma Revisão Integrativa

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