Advertisement
ADVANCED SEARCH

This Article Full Text Full Text (PDF) [Original PDF] Correction (v170,p771) Submit a response View responses Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Forster, A. J. Articles by van Walraven, C. Search for Related Content PubMed PubMed Citation Articles by Forster, A. J. Articles by van Walraven, C. Related Collections Other public health Organization of health care Patient safety, clinical risk, medical error Related Article

Adverse events among medical patients after discharge from hospital

From the Clinical Epidemiology Program, Ottawa Health Research Institute (Forster, Clark, van Walraven); the Department of Medicine, University of Ottawa (all authors), Ottawa, Ont.; and the Institute for Clinical Evaluative Sciences (van Walraven), Toronto, Ont.

Correspondence to: Dr. Alan J. Forster, Ottawa Hospital, Civic Campus, F654-1053 Carling Ave., Ottawa ON K1Y 4E9; fax 613 761-5351; aforster{at}ohri.ca

Background: Adverse events (AEs) are adverse outcomes caused by medical care. Several studies have indicated that a substantial number of patients experience AEs before or during hospitalization. However, few data describe AEs after hospital discharge. We determined the incidence, severity, preventability and ameliorability of AEs in patients discharged from the general internal medicine service of a Canadian hospital.

Methods: At a multisite Canadian teaching hospital, we prospectively studied patients who were consecutively discharged home or to a seniors' residence from the general internal medicine service during a 14-week interval in 2002. We used telephone interview and chart review to identify outcomes after discharge. Two physicians independently reviewed each outcome to determine if the patient experienced an AE. The severity, preventability and ameliorability of all AEs were classified.

Results: During the study period, outcomes were determined for 328 of the 361 eligible patients, who averaged 71 years of age (interquartile range 54–81 years). After discharge, 76 of the 328 patients experienced at least 1 AE (overall incidence 23%, 95% confidence interval [CI] 19%–28%). The AE severity ranged from symptoms only (68% of the AEs) or symptoms associated with a nonpermanent disability (25%) to permanent disability (3%) or death (3%). The most common AEs were adverse drug events (72%), therapeutic errors (16%) and nosocomial infections (11%). Of the 76 patients, 38 had an AE that was either preventable or ameliorable (overall incidence 12%, 95% CI 9%–16%).

Interpretation: Approximately one-quarter of patients in our study had an AE after hospital discharge, and half of the AEs were preventable or ameliorable.

This article has been cited by other articles:

				F. D. Wolinsky, S. E. Bentler, L. Liu, M. P. Jones, B. Kaskie, J. Hockenberry, E. A. Chrischilles, K. B. Wright, J. F. Geweke, M. Obrizan, et al. Prior Hospitalization and the Risk of Heart Attack in Older Adults: A 12-Year Prospective Study of Medicare Beneficiaries J Gerontol A Biol Sci Med Sci, January 27, 2010; (2010): glq003v1 - glq003. [Abstract] [Full Text] [PDF]

				A. McKinnon and D. Jorgenson Pharmacist and physician collaborative prescribing: For medication renewals within a primary health centre Can Fam Physician, December 1, 2009; 55(12): e86 - e91. [Abstract] [Full Text] [PDF]

				C. M. Clancy Reengineering Hospital Discharge: A Protocol to Improve Patient Safety, Reduce Costs, and Boost Patient Satisfaction American Journal of Medical Quality, July 1, 2009; 24(4): 344 - 346. [PDF]

				D. W Bates, I. Larizgoitia, N. Prasopa-Plaizier, A. K Jha, and on behalf of the Research Priority Setting Working Global priorities for patient safety research BMJ, May 14, 2009; 338(may14_1): b1775 - b1775. [Full Text]

				C. L. Graham, S. L. Ivey, and L. Neuhauser From Hospital to Home: Assessing the Transitional Care Needs of Vulnerable Seniors Gerontologist, March 13, 2009; (2009) gnp005v1. [Abstract] [Full Text] [PDF]

				F. D. Wolinsky, S. E. Bentler, L. Liu, M. Obrizan, E. A. Cook, K. B. Wright, J. F. Geweke, E. A. Chrischilles, C. E. Pavlik, R. L. Ohsfeldt, et al. Recent Hospitalization and the Risk of Hip Fracture Among Older Americans J Gerontol A Biol Sci Med Sci, February 4, 2009; (2009) gln027v1. [Abstract] [Full Text] [PDF]

				B. W. Jack, V. K. Chetty, D. Anthony, J. L. Greenwald, G. M. Sanchez, A. E. Johnson, S. R. Forsythe, J. K. O'Donnell, M. K. Paasche-Orlow, C. Manasseh, et al. A Reengineered Hospital Discharge Program to Decrease Rehospitalization: A Randomized Trial Ann Intern Med, February 3, 2009; 150(3): 178 - 187. [Abstract] [Full Text] [PDF]

				J. S Tripp, S. P Narus, M. K Magill, and S. M Huff Evaluating the Accuracy of Existing EMR Data as Predictors of Follow-up Providers JAMIA, November 1, 2008; 15(6): 787 - 790. [Abstract] [Full Text] [PDF]

				J. D Wong, J. M Bajcar, G. G Wong, S. M. Alibhai, J.-H. Huh, A. Cesta, G. R Pond, and O. A Fernandes Medication Reconciliation at Hospital Discharge: Evaluating Discrepancies Ann. Pharmacother., October 1, 2008; 42(10): 1373 - 1379. [Abstract] [Full Text] [PDF]

				C Huang, P Loewen, T Pelletier, J Slater, and M Chung Implementation of proven interventions in general medical inpatients: development and evaluation of a new quality indicator for drug therapy Qual. Saf. Health Care, August 1, 2008; 17(4): 269 - 274. [Abstract] [Full Text] [PDF]

				N. J. MacKinnon and C. Sanmartin Middle of the health care pack: Canada's performance in the 2007 Commonwealth Fund international survey Can Fam Physician, July 1, 2008; 54(7): 965 - 966. [Full Text] [PDF]

				N. J. MacKinnon and C. Sanmartin Au milieu du peloton en matiere de sante: Le rendement du Canada dans le sondage international du Fonds du Commonwealth en 2007 Can Fam Physician, July 1, 2008; 54(7): 970 - 971. [Full Text] [PDF]

				P. J. Zed PharmD, R. B. Abu-Laban MD MHSc, R. M. Balen PharmD, P. S. Loewen PharmD, C. M. Hohl MD, J. R. Brubacher MD MSc, K. Wilbur PharmD, M. O. Wiens BSc(Pharm), L. J. Samoy BSc(Pharm), K. Lacaria BSc(Pharm), et al. Incidence, severity and preventability of medication-related visits to the emergency department: a prospective study Can. Med. Assoc. J., June 3, 2008; 178(12): 1563 - 1569. [Abstract] [Full Text] [PDF]

				E M A Witherington, O M Pirzada, and A J Avery Communication gaps and readmissions to hospital for patients aged 75 years and older: observational study Qual. Saf. Health Care, February 1, 2008; 17(1): 71 - 75. [Abstract] [Full Text] [PDF]

				C. Moore, T. McGinn, and E. Halm Tying Up Loose Ends: Discharging Patients With Unresolved Medical Issues Arch Intern Med, June 25, 2007; 167(12): 1305 - 1311. [Abstract] [Full Text] [PDF]

				A. J Forster, N. G W Rose, C. van Walraven, and I. Stiell Adverse events following an emergency department visit Qual. Saf. Health Care, February 1, 2007; 16(1): 17 - 22. [Abstract] [Full Text] [PDF]

				S. Olsen, G. Neale, K. Schwab, B. Psaila, T. Patel, E J. Chapman, and C. Vincent Hospital staff should use more than one method to detect adverse events and potential adverse events: incident reporting, pharmacist surveillance and local real-time record review may all have a place Qual. Saf. Health Care, February 1, 2007; 16(1): 40 - 44. [Abstract] [Full Text] [PDF]

				E. G Poon, B. Blumenfeld, C. Hamann, A. Turchin, E. Graydon-Baker, P. C McCarthy, J. Poikonen, P. Mar, J. L Schnipper, R. K Hallisey, et al. Design and Implementation of an Application and Associated Services to Support Interdisciplinary Medication Reconciliation Efforts at an Integrated Healthcare Delivery Network JAMIA, November 1, 2006; 13(6): 581 - 592. [Abstract] [Full Text] [PDF]

				P B Marck, J A Kwan, B Preville, M Reynes, W Morgan-Eckley, R Versluys, L Chivers, B O'Brien, J Van der Zalm, M Swankhuizen, et al. Building safer systems by ecological design: using restoration science to develop a medication safety intervention. Qual. Saf. Health Care, April 1, 2006; 15(2): 92 - 97. [Abstract] [Full Text] [PDF]

				T Vira, M Colquhoun, and E Etchells Reconcilable differences: correcting medication errors at hospital admission and discharge. Qual. Saf. Health Care, April 1, 2006; 15(2): 122 - 126. [Abstract] [Full Text] [PDF]

				J. L. Schnipper, J. L. Kirwin, M. C. Cotugno, S. A. Wahlstrom, B. A. Brown, E. Tarvin, A. Kachalia, M. Horng, C. L. Roy, S. C. McKean, et al. Role of Pharmacist Counseling in Preventing Adverse Drug Events After Hospitalization. Arch Intern Med, March 13, 2006; 166(5): 565 - 571. [Abstract] [Full Text] [PDF]

				R. Tamblyn, A. Huang, Y. Kawasumi, G. Bartlett, R. Grad, A. Jacques, M. Dawes, M. Abrahamowicz, R. Perreault, L. Taylor, et al. The Development and Evaluation of an Integrated Electronic Prescribing and Drug Management System for Primary Care JAMIA, March 1, 2006; 13(2): 148 - 159. [Abstract] [Full Text] [PDF]

				J. G. Wiese and R. L. Holman Update in Hospital Medicine Ann Intern Med, February 7, 2006; 144(3): 195 - 200. [Full Text] [PDF]

				J. Braithwaite Hunter-gatherer human nature and health system safety: an evolutionary cleft stick? Int. J. Qual. Health Care, December 1, 2005; 17(6): 541 - 545. [Abstract] [Full Text] [PDF]

				A. J. Forster, K. G. Shojania, and C. van Walraven Improving patient safety: moving beyond the "hype" of medical errors Can. Med. Assoc. J., October 11, 2005; 173(8): 893 - 894. [Full Text] [PDF]

				P. J. Zed Drug-Related Visits to the Emergency Department Journal of Pharmacy Practice, October 1, 2005; 18(5): 329 - 335. [Abstract] [PDF]

				E. J. Jones, N. J MacKinnon, and R. T Tsuyuki Pharmaceutical Care in Community Pharmacies: Practice and Research in Canada Ann. Pharmacother., September 1, 2005; 39(9): 1527 - 1533. [Abstract] [Full Text] [PDF]

				P. L. Cornish, S. R. Knowles, R. Marchesano, V. Tam, S. Shadowitz, D. N. Juurlink, and E. E. Etchells Unintended Medication Discrepancies at the Time of Hospital Admission Arch Intern Med, February 28, 2005; 165(4): 424 - 429. [Abstract] [Full Text] [PDF]

				N. C. Elder and J. Hickner Missing Clinical Information: The System Is Down JAMA, February 2, 2005; 293(5): 617 - 619. [Full Text] [PDF]

				A. J. Forster and C. v. Walraven Reducing adverse events Can. Med. Assoc. J., May 25, 2004; 170(11): 1650 - 1650. [Full Text]

				G. R. Baker, P. G. Norton, V. Flintoft, R. Blais, A. Brown, J. Cox, E. Etchells, W. A. Ghali, P. Hebert, S. R. Majumdar, et al. The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada Can. Med. Assoc. J., May 25, 2004; 170(11): 1678 - 1686. [Abstract] [Full Text]

				W. McLean Reducing adverse events Can. Med. Assoc. J., May 25, 2004; 170(11): 1647 - 1647. [Full Text]

				G. R. Baker and P. G. Norton Adverse events and patient safety in Canadian health care Can. Med. Assoc. J., February 3, 2004; 170(3): 353 - 354. [Full Text] [PDF]

eLetters:

HOME	CURRENT ISSUE	PAST ISSUES	COLLECTIONS	HELP	SEARCH
Copyright 1995-2004, Canadian Medical Association. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p) All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.