Drug-related emergency department visits in an elderly veteran population.
BACKGROUND
Given that adverse drug events result in extensive costs and healthcare resource utilization, the goal is to better understand drug-related emergency department (ED) visits so that programs can be implemented to improve the quality of health care.


OBJECTIVE
To (1) determine the incidence of drug-related ED visits at a large, tertiary care, Veterans Affairs hospital; (2) identify causes of these drug-related ED visits; (3) determine patient outcomes, healthcare resource utilization, and costs associated with these visits; and (4) determine the proportion of adverse drug reaction (ADR)-related ED visits that were spontaneously reported to the hospital's ADR reporting program.


METHODS
We conducted a retrospective electronic chart review of all patients who visited the ED during the second week of each month in 2003. Causes for drug-related visits were identified. ADRs in this study included side effects, drug allergies, and drug-drug interactions (DDIs) and were assessed using the Naranjo probability scale.


RESULTS
A total of 2169 patients were included in the study. Drug-related visits accounted for 12.6% of all ED visits. The main causes of drug-related visits were ADRs and nonadherence, which accounted for 33% and 19% of drug-related visits, respectively. Only 11% of these ADRs were spontaneously reported to the hospital's ADR reporting program. Thirty-five percent of drug-related visits led to hospitalizations, which resulted in an average length of stay of 9.3 days. The institution's total cost of drug-related visits was approximately 1.5 million US dollars over 12 weeks.


CONCLUSIONS
Many ED visits are drug related and often result in hospitalization and increased healthcare resource utilization. Only a minimal number of the ADRs resulting in ED visits are spontaneously reported to hospital ADR reporting programs.
Yee
Jennie L
JL
Drug Information, Blue Shield of California, San Francisco, USA.
Hasson
Noelle K
NK
Schreiber
Donald H
DH
D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D003365:Costs and Cost Analysis; D062787:Drug Overdose; D011307:Drug Prescriptions / Q000191:economics / Q000706:statistics & numerical data; D064420:Drug-Related Side Effects and Adverse Reactions; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D004364:Pharmaceutical Preparations / Q000191:economics; D012189:Retrospective Studies; D019966:Substance-Related Disorders; D017211:Treatment Failure; D014728:Veterans / Q000706:statistics & numerical data*
D004364:Pharmaceutical Preparations