Adverse drug events occurring following hospital discharge.
OBJECTIVE
To describe the incidence of adverse drug events (ADEs), preventable ADEs, and ameliorable ADEs occurring after hospital discharge and their associated risk factors.


METHODS
Prospective cohort study.


METHODS
Urban academic health sciences center.


METHODS
Consecutive patients discharged home from the general medical service.


METHODS
We determined posthospital outcomes approximately 24 days following discharge by performing a chart review and telephone interview. Using the telephone interview, we identified new or worsening symptoms, the patient's health system use, and recollection of processes of care. Posthospital outcomes were judged by 2 internists independently.


RESULTS
Four hundred of 581 potentially eligible patients were evaluated. Of the 400 patients, 45 developed an ADE (incidence, 11%; 95% confidence interval [CI], 8% to 14%). Of these, 27% were preventable and 33% were ameliorable. Injuries were significant in 32 patients, serious in 6, and life threatening in 7. Patients were less likely to experience an ADE if they recalled having side effects of prescribed medications explained (OR, 0.4; 95% CI, 0.2 to 0.8). The risk of ADE per prescription was highest for corticosteroids, anticoagulants, antibiotics, analgesics, and cardiovascular medications. Risk increased with prescription number. Failure to monitor was an especially common cause of preventable and ameliorable ADEs.


CONCLUSIONS
Following discharge, ADEs were common and many were preventable or ameliorable. Medication side effects should be discussed, and interventions should include better monitoring and target patients receiving specific drug classes or multiple medications.
Forster
Alan J
AJ
Division of General Internal Medicine and Ottawa Health Research Institute, University of Ottawa, Ottawa, Ontario, Canada. aforster@ohri.ca
Murff
Harvey J
HJ
Peterson
Josh F
JF
Gandhi
Tejal K
TK
Bates
David W
DW
D001900:Boston; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D008297:Male; D008485:Medical Audit; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D012189:Retrospective Studies; D012307:Risk Factors