Impact of patient communication problems on the risk of preventable adverse events in acute care settings.
BACKGROUND
Up to 50% of adverse events that occur in hospitals are preventable. Language barriers and disabilities that affect communication have been shown to decrease quality of care. We sought to assess whether communication problems are associated with an increased risk of preventable adverse events.


METHODS
We randomly selected 20 general hospitals in the province of Quebec with at least 1500 annual admissions. Of the 145,672 admissions to the selected hospitals in 2000/01, we randomly selected and reviewed 2355 charts of patients aged 18 years or older. Reviewers abstracted patient characteristics, including communication problems, and details of hospital admission, and assessed the cause and preventability of identified adverse events. The primary outcome was adverse events.


RESULTS
Of 217 adverse events, 63 (29%) were judged to be preventable, for an overall population rate of 2.7% (95% confidence interval [CI] 2.1%-3.4%). We found that patients with preventable adverse events were significantly more likely than those without such events to have a communication problem (odds ratio [OR] 3.00; 95% CI 1.43-6.27) or a psychiatric disorder (OR 2.35; 95% CI 1.09-5.05). Patients who were admitted urgently were significantly more likely than patients whose admissions were elective to experience an event (OR 1.64, 95% CI 1.07-2.52). Preventable adverse events were mainly due to drug errors (40%) or poor clinical management (32%). We found that patients with communication problems were more likely than patients without these problems to experience multiple preventable adverse events (46% v. 20%; p = 0.05).


CONCLUSIONS
Patients with communication problems appeared to be at highest risk for preventable adverse events. Interventions to reduce the risk for these patients need to be developed and evaluated.
Department of Family Medicine, McGill University, Montréal, Que. gillian.bartlett@mcgill.ca
Gillian
G
Bartlett
Régis
R
Blais
Robyn
R
Tamblyn
Richard J
RJ
Clermont
Brenda
B
MacGibbon
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada / Q000453:epidemiology; D003144:Communication Barriers; D005260:Female; D006276:Health Facility Size; D017052:Hospital Mortality; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology* / Q000517:prevention & control; D008297:Male; D019300:Medical Errors / Q000517:prevention & control*; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D005791:Patient Care / Q000592:standards*; D011369:Professional-Patient Relations; D011787:Quality of Health Care; D012189:Retrospective Studies; D012307:Risk Factors