title: Practical approach to determining costs and frequency of adverse drug events in a health care network.
abstract: The frequency, preventability, severity, root causes, and projected costs of adverse drug events (ADEs) occurring after or causing admission to a four-hospital integrated academic health network were studied. The sample included all admissions during a 53-day study period. Events were identified through daily record review of a random patient sample, computerized flags, and self-reporting. A case review committee validated the occurrence, classification, and root causes of the events. Additional length of stay and costs associated with ADEs were analyzed by using a case-control, multiple linear regression model. The estimated ADE rate during hospitalization was 4.2 events per 100 admissions, with a cost of $2162 per ADE. In addition, 3.2% of admissions were caused by ADEs, with an associated cost of $6685 per event. Fifteen percent of hospital ADEs and 76% of ADEs causing admission were judged preventable. The annual cost to the organization for events occurring during hospitalization was $1.7 million, and the cost of preventable ADEs was $260,000, while the projected costs of preventable ADEs causing admission were $3.8 million. The rate of admissions to the mental health center caused by ADEs was higher than for other settings at 13.6%, with a cost of preventable ADEs of $1.3 million. Patient noncompliance was judged to be the cause of the 69% of the ADEs causing admission. Seventy-one percent of the serious medication errors occurred at the prescribing stage of the medication-use process. ADEs were frequent, costly, and often preventable and resulted in many admissions to a mental health center.
authors.affiliation: Fairview-University Medical Center, University Campus MMC611 D147, 420 Delaware Street S.E., Minneapolis, MN 55455, USA. bsenst1@fairview.org
authors.forename: B L
authors.initials: BL
authors.lastname: Senst
authors.forename: L E
authors.initials: LE
authors.lastname: Achusim
authors.forename: R P
authors.initials: RP
authors.lastname: Genest
authors.forename: L A
authors.initials: LA
authors.lastname: Cosentino
authors.forename: C C
authors.initials: CC
authors.lastname: Ford
authors.forename: J A
authors.initials: JA
authors.lastname: Little
authors.forename: S J
authors.initials: SJ
authors.lastname: Raybon
authors.forename: D W
authors.initials: DW
authors.lastname: Bates
mesh_terms: D003365:Costs and Cost Analysis; D064420:Drug-Related Side Effects and Adverse Reactions; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008508:Medication Errors / Q000191:economics / Q000517:prevention & control / Q000706:statistics & numerical data; D009516:New Mexico / Q000453:epidemiology; D010607:Pharmacy Service, Hospital / Q000191:economics* / Q000706:statistics & numerical data; D012720:Severity of Illness Index