Adverse Events During Hospitalization: Results of a Patient Survey

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Article-at-a-Glance

Background

A two-stage probability sample of patients recently discharged from 16 general acute care hospitals in Massachusetts were interviewed to determine the rates at which patients experience what they considered to be adverse events, to describe the kinds of events they reported, and to identify the correlates of those reports.

Methods

Eligible respondents were adults, 18 years of age or older, who were medical or surgical patients overnight or longer between April 1 and October 1, 2003, and who were discharged to their homes in Massachusetts. Questions covered perceptions of adverse events during hospitalizations and possible correlates of those events. Telephone interviews were carried out an average of nine months after discharge with 2,582 patients (response rate, 53%–60%).

Results

Twenty-nine percent of respondents reported at least one unexpected “negative” event during their hospitalization. After physician review, the revised estimate was that 25% perceived that they had experienced at least one event that met our definition for an adverse event. The most common reported events were reactions to newly prescribed drugs (40%) and the effects of surgery (34%). Physician reviewers coded 57% of the adverse events as “significant” and 18% as “serious” or “life-threatening.” The physician reviewers also rated 31% of the reported adverse events as likely to be preventable.

Discussion

The estimate that one in four hospital patients experienced an adverse event is considerably higher than the published rates based on hospital record review, indicating the potential value of surveys for studies of patient safety. Because of nonresponse among older patients, that estimate is probably an underestimate. Designs that would reduce lags between discharge and interviews and decrease hospital nonresponses would reduce two key threats to confidence in the survey results.

Section snippets

Sampling

The goal was to interview a sample of patients 18 years of age or older who were hospitalized for medical or surgical treatment (psychiatric and obstetrical admissions were excluded) and who were discharged from Massachusetts hospitals between April 1 and October 1, 2003.

We drew a two-stage probability sample from the 71 general acute care hospitals in 2003 in Massachusetts. The five largest (on the basis of bed size) hospitals were selected with certainty. The remaining 66 were put into three

Data Collection

Of the initial sample of 20 hospitals, 5 had to be replaced by randomly selecting another hospital from the same stratum. In three cases, more than 1 hospital was approached before a willing replacement was found. In addition, at a point that was too late to consider replacement, 4 other hospitals withdrew, including 1 from the large hospital stratum.

The initial sample included 5,859 patients from 16 hospitals, of whom 963 were ineligible because they were deceased, were living in a nursing

Discussion

The data reported in this article indicate that about one fourth of hospitalized patients report that they experienced an adverse event resulting from their care in the hospital and that three quarters of those events appeared to physician reviewers to be at least “significant” in severity. Those rates are higher than adverse event rates estimated from review of hospital records, 4., 6., 8. which range from 3% to 11%, depending on the patient population and definition of adverse events.

The

References (20)

  • S.N. Weingart

    Patient-reported safety and quality issues in outpatient oncology

    Jt Comm J Qual Patient Saf

    (Feb. 2007)
  • To Err Is Human: Building a Safer Health System

    (2000)
  • Patients, Doctors, Lawyers: Medical Injury, Malpractice Litigation and Compensation in New York

    (1990)
  • L.L. Leape

    The nature of adverse events in hospitalized patients: Results of the Harvard Medical Practice Study II

    N Engl J Med

    (Feb. 7, 1991)
  • T.A. Brennan

    Incidence of adverse events and negligence in hospitalized patients: Results of the Harvard Medical Practice Study I

    N Engl J Med

    (Feb. 7, 1991)
  • M.R. Miller

    Patient safety events during pediatric hospitalizations

    Pediatrics

    (Jun. 2003)
  • C. Vincent

    Adverse events in British hospitals: Preliminary retrospective record review

    Br Med J

    (Mar. 3, 2001)
  • C. Zhan et al.

    Excess length of stay, charges, and mortality attributable to medical injuries during hospitalization

    JAMA

    (Oct. 8, 2003)
  • E.J. Thomas et al.

    Incidence and types of preventable adverse events in elderly patients: Population based review of medical records

    BMJ

    (Mar. 18, 2000)
  • J.M. Rothschild

    The Critical Care Safety Study: The incidence and nature of adverse events and serious medical errors in intensive care

    Crit Care Med

    (Aug. 2005)
There are more references available in the full text version of this article.

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