Description | Parameter | Source |
Annual hospital activity in England | ||
Number of FAEs | 17 127 498 episodes | NHS Digital28 |
Number of overnight admissions: total number of FAEs minus number of day case finished consultant episodes (7 386 255) | 9 741 243 admissions | NHS Digital28 |
Number of intrahospital transitions: 71.7% of patients in an observational study of elderly (median age: 79 years) patients had at least one intrahospital transfer during their overnight admission. Intrahospital transfers in general population was assumed to be one-quarter of this rate (ie, 17.9% of overnight admissions) supported by expert opinion. | 1 746 118 transitions | Boncea et al 30; expert opinion |
Number of interhospital transitions: estimated from ambulance activity data (category 1–4 interfacility transfer incidents) | 222 794 transitions | Ambulance System Indicators for England (2021–22)29 |
Number of FAEs discharged: same as total number of FAEs | 17 127 498 discharges | NHS Digital28 |
Annual prescribing activity in England | ||
Mean number of items prescribed at inpatient admission, also assumed to be number of items prescribed at intrahospital and interhospital transitions | 4.78 items | Ashcroft et al 26 |
Mean number of items per discharge prescription | 4.9 items | Lloyd et al 27 |
Number of items prescribed at overnight hospital admission | 46 521 652 items | Calculated from number of event and items prescribed |
Number of items prescribed at intrahospital transitions | 8 339 006 items | |
Number of items prescribed at interhospital transitions | 1 064 006 items | |
Number of items prescribed at discharge | 83 518 624 items | |
Prevalence of errors | ||
RRR in medication errors at transfer following medicines reconciliation (vs no medicines reconciliation) | RRR 0.13 (log-normal dist; alpha: −2.04; beta: 0.163) | Redmond et al 5 |
Medication error rate at admission and interhospital transition Detected by meds rec: 13.28% (beta dist; alpha: 5910; beta: 38 586) Total: 15.30% | Undetected by meds rec 1.99% | Ashcroft et al 26; calculated using Redmond et al 5 |
Medication error rate at intrahospital transition Detected by meds rec: 3.94% (beta dist; alpha: 598; beta: 14 591) Total: 4.50% | Undetected by meds rec 0.58% | Ashcroft et al
26; calculated using Redmond et al 5 |
Medication error rate at discharge Detected by meds rec: 6.31% (beta dist; alpha: 1989; beta: 29 513) Total: 7.20% | Undetected by meds rec 0.94% | Ashcroft et al 26; calculated using Redmond et al 5 |
Harm from errors | ||
Errors at inpatient admission, intrahospital and interhospital transition leading to harm:
Proportion of inpatient episodes where an ADE occurs Proportion of ADEs that are definitely avoidable (ie, harm from an error) Proportion of inpatient episodes with an ADE (ie, definitely avoidable ADE) (14.7%×6.4%) Proportion of ADEs related to drugs that were initiated prior to hospitalisation (131 out of 733 ADEs) | 14.7% (beta dist; alpha: 535; beta: 3107) 6.4% (beta dist; alpha: 45; beta: 665) 0.9% 17.9% | Davies et al 31 |
Burden of harm from errors at inpatient admission, intrahospital and interhospital transition: proportion of people with extended admission due to harm mean additional length of stay | 26.8% (beta dist; alpha: 147; beta: 398) 4 days | Davies et al 31 |
Burden of harm from errors at inpatient admission, intrahospital and interhospital transition: proportion of people who have an ADR that die as a result | 0.18% (beta dist; alpha: 1; beta: 544) | Davies et al 31 |
Errors at discharge leading to harm: proportion of people with medication-related harm following hospital discharge who were readmitted to hospital | 21.1% (beta dist; alpha: 87; beta: 326) | Parekh et al 32 |
Burden of harm from errors at discharge: median duration of admissions due to ADE | 6 days | Osanlou et al 33 |
Burden of harm from errors at discharge: proportion of people admitted to hospital due to an ADE who died as a result | 0.42% | Osanlou et al 33 |
Unit costs | ||
Cost per excess bed day in hospital (weighted mean of elective and non-elective) | £372 | NHS schedule of reference costs43
NHSCII pay and prices index for inflation44 |
Cost of a non-elective inpatient admission | £3626 | NHS schedule of reference costs45
NHSCII pay and prices index for inflation44 |
ADE, adverse drug event; ADR, adverse drug reaction; Dist, distribution; FAEs, finished admission episodes; meds rec, medication reconciliation; NHS, National Health Service; RRR, relative risk reduction.