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3/10/2003

Adverse Events Occur After Hospital Discharge, Study Finds

Kate Traynor

A recently published report revealed that nearly one in five patients suffer adverse events—many of which are preventable—fairly soon after coming home from the hospital.1

According to the report, 76 of 400 consecutively discharged patients suffered a combined total of 78 adverse events within five weeks after being discharged home from the hospital. Twenty-three of the adverse events were deemed to be preventable, and 24 were classified as ameliorable, or of a severity that could have been greatly reduced by altering procedures for patient care.

The most common problems identified in the study were drug-related adverse events, accounting for 66% of the total adverse events. Antimicrobials  caused 38% of the drug-related adverse events; corticosteroids, 16%; cardiovascular drugs, 14%; opiates and other analgesics, 10%; and anticoagulants, 8%. The next most common adverse events were related to medical procedures and constituted 17% of all incidents described in the report.

A preventable toxic response to a drug was blamed for one of the two adverse events that resulted in permanent disability. Overall, however, permanent or temporary disability from preventable or unavoidable medication errors was rare, accounting for 6 of 50 drug-related adverse events. Thirty-nine of the drug-related adverse events were instances of troublesome symptoms that persisted for more than a day.

According to the report, so-called system problems in the hospital contributed to each of the 47 preventable or ameliorable adverse events. About 60% of these incidents were blamed on poor communication between the hospital staff and the patient or the patient’s primary care physician.

To remedy these problems, the report’s authors suggested strategies that included educating patients about their drug therapy before discharge from the hospital and monitoring drug therapy afterward. A specific suggestion was made to have a clinical pharmacist telephone patients for follow-up information within five days after discharge.

“Clinical pharmacists could go through the medications that were prescribed and verify their accuracy and also assess whether patients were having the desired results and whether they perceived any adverse effects from the medication,” said David W. Bates, chief of the Division of General Medicine at Brigham and Women’s Hospital in Boston and one of the report’s authors.

The study took place over an 81-day period and involved patients at an 800-bed urban teaching hospital. An internist contacted adult patients by telephone between two and five weeks after discharge and inquired about adverse events that had occurred after the hospital stay ended. On average, patients completed the survey 24 days after leaving the hospital.

Patients who responded to the survey were 57 years old on average. Most had received care in the hospital for lung or cardiovascular disease. Sixty-one percent of the survey respondents were women.

After completing the telephone interviews, the internist sought additional details on each patient’s hospital stay using information from electronic medical records. This was supplemented, when necessary, with information from patients’ paper medical files. With this data, the internist prepared a case summary for each patient who completed an interview. Case summaries included an event summary for each patient who suffered a postdischarge adverse event.

The report’s authors used a broad definition of adverse events, including incidents that did not result in readmission to the hospital. Such adverse events included drug-related rashes, constipation resulting from taking opiates without concurrent use of a stool softener, and other gastrointestinal reactions to prescribed medications.

Bates did not seem surprised that so many of the adverse events described in his report were the result of medication use. “Medications are enormously important for treating a wide variety of common conditions,” he said. “Successful treatment requires close titration of those medications.”

In this type of environment, Bates said, pharmacists’ expertise in medication management is very important.

“The role of pharmacy is changing,” Bates said, adding that he expects to see more pharmacists assuming clinical roles in the future.

  1. Forster AJ, Murff HJ, Peterson JF et al. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003; 138:161-7.