What are the safety risks for patients undergoing treatment by multiple specialties: a retrospective patient record review study

BACKGROUND: If multiple medical specialties are involved in treatment there is a danger of increasing risks to patient safety. This is due to the need for greater co-ordination and communication with other specialties, less emergency cover for individual sub-specialties, and a drop in general care and the overview of care. This study aims to determine if the number of medical specialties treating a patient is associated with the risk of experiencing harm during hospital admission. METHODS: We performed a retrospective patient record review study using a stratified sample of 20 hospitals in the Netherlands. In each hospital 200 patient admissions were included. We related the occurrence of preventable adverse events and non-preventable adverse events to the number of specialties treating a patient through a stepwise multilevel logistic regression analysis. RESULTS: Compared to patients treated by only one specialty, patients treated by three or more specialties had an odds ratio of experiencing an adverse event of 3.01 (95% CI 2.09 to 4.34), and an odds ratio of experiencing a preventable adverse event of 2.78 (95% CI 1.77 to 4.37). After adding characteristics related to the patient and the type of health care, the odds ratio for non-preventable adverse events decreased to 1.46 (95% CI 0.95 to 2.26), and for preventable adverse events to 2.31 (95% CI 1.40 to 3.81). There were no large differences found between the groups relating to the causes of preventable adverse events. However, in patients treated by three or more specialties, the greater number of preventable adverse events was related to the diagnostic process. CONCLUSIONS: The more specialties treating a patient the greater the risk of an adverse event. This finding became more pronounced for preventable adverse events than for non-preventable adverse events after corrections for the characteristics of the patient and their health care. This study highlights the importance of taking the number of specialties treating a patient into account. More research is needed to gain insight into the underlying causes of inadequate care when multiple specialties are required to treat a patient. This could result in appropriate solutions resulting in improvements to care.