title: [Adverse outcome screening in hospitalizations of the Brazilian Unified Health System].
abstract: OBJECTIVE
  To assess the frequency of screening for potential adverse outcomes in hospitalizations of the Brazilian Unified Health System.
  
  
  METHODS
  A retrospective study, including all hospital admissions of adults in medical clinics (n = 3,565,811) and surgical clinics (n = 2,614,048) in Brazil in 2007. The Hospital Information System was used as a source of information. The measurement of adverse events was based on screening for eleven clinical conditions, as defined by previous international studies, recorded in the secondary diagnosis field. We performed bivariate and multivariate analysis to investigate associations between adverse events, death (dependent variable) and other variables such as age, use of the intensive care unit and performance of surgery.
  
  
  RESULTS
  The frequency obtained for both clinic types was 3.6 potential adverse events per 1,000 admissions, with a greater frequency in medical clinics (5.3 per 1,000) than in surgery clinics (1.3 per 1,000). There were differences in the profile of hospital admissions between the two clinics: medical clinics were characterized by a predominance of older adults, longer average length of stay, higher mortality rate and lower total cost of hospitalization. The most common potential adverse outcome was hospital-acquired pneumonia. Cardiac arrest had a higher risk of death (OR= 5.76) compared to other potential adverse outcomes. Increased cost for hospitalizations was associated with sepsis. The conditions used as the screening criteria were associated with greater odds of death even after the introduction of variables such as use of intensive care and surgery.
  
  
  CONCLUSIONS
  The high frequency of adverse outcomes in hospital admissions indicates a need to develop monitoring strategies and to improve quality of care for improved patient safety.
authors: Programa de Pós-Graduação em Saúde Pública, Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil. moniguilar@gmail.com
authors: Monica Aguilar Estevam
authors: MA
authors: Dias
authors: Monica
authors: M
authors: Martins
authors: Nair
authors: N
authors: Navarro
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D004812:Epidemiologic Methods; D005260:Female; D006751:Hospital Information Systems; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000458:organization & administration; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010343:Patient Admission; D061214:Patient Safety; D012737:Sex Factors