Adverse events among medical patients after discharge from hospital.
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%).


CONCLUSIONS
Approximately one-quarter of patients in our study had an AE after hospital discharge, and half of the AEs were preventable or ameliorable.
Forster
Alan J
AJ
Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Ontario, Canada. aforster@ohri.ca
Clark
Heather D
HD
Menard
Alex
A
Dupuis
Natalie
N
Chernish
Robert
R
Chandok
Natasha
N
Khan
Asmat
A
van Walraven
Carl
C
D016907:Adverse Drug Reaction Reporting Systems; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D003428:Cross Infection / Q000150:complications*; D005260:Female; D006784:Hospitals, Teaching / Q000592:standards*; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000009:adverse effects* / Q000706:statistics & numerical data; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D011446:Prospective Studies; D011785:Quality Assurance, Health Care