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Contribution of adverse events to death of hospitalised patients

BACKGROUND: There is no standardised method to investigate death as a patient safety indicator and we need valid and reliable measurements to use adverse events contributing to death as a quality measure. OBJECTIVE: To investigate the contribution of severe adverse events to death in hospitalised pa...

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Autores principales: Haukland, Ellinor Christin, Mevik, Kjersti, von Plessen, Christian, Nieder, Carsten, Vonen, Barthold
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6440591/
https://www.ncbi.nlm.nih.gov/pubmed/30997413
http://dx.doi.org/10.1136/bmjoq-2018-000377
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author Haukland, Ellinor Christin
Mevik, Kjersti
von Plessen, Christian
Nieder, Carsten
Vonen, Barthold
author_facet Haukland, Ellinor Christin
Mevik, Kjersti
von Plessen, Christian
Nieder, Carsten
Vonen, Barthold
author_sort Haukland, Ellinor Christin
collection PubMed
description BACKGROUND: There is no standardised method to investigate death as a patient safety indicator and we need valid and reliable measurements to use adverse events contributing to death as a quality measure. OBJECTIVE: To investigate the contribution of severe adverse events to death in hospitalised patients and clarify methodological differences using the Global Trigger Tool method on all inpatient deaths compared with a sample of general hospitalised patients. METHOD: Retrospective records reviewing using the Global Trigger Tool method. RESULTS: In 0.3% of hospital admissions, adverse events contribute to inpatient death. Patients who die in hospital have twice the rate of adverse events per 1000 patient days compared with general patients, 76.7 vs 36.5 (p<0.001, RR 2.10, 95% CI 1.79 to 2.47). Patients dying in hospital experience seven times the rate of severe adverse events, 38.4% vs 5.2% (p<0.001, RR 2.10, 95% CI 1.79 to 2.47). For 86 out of 377 inpatient deaths, the adverse event is so severe that it contributes to death. 27.9% of severe adverse events contributing to death originate in primary care. Lower respiratory infections (p<0.001, RR 2.81, 95% CI 1.76 to 4.51), medication harm (p<0.001, RR 5.21, 95% CI 3.04 to 8.94) and pressure ulcers (p=0.04, RR 2.23, 95% CI 1.03 to 4.85) are significantly more frequent for inpatient deaths than in the general sample of hospital patients. CONCLUSIONS: Patients dying in hospitals experience seven times the rate of severe adverse events. Reviewing all inpatient death by the Global Trigger Tool method discloses new valid and reliable data of severe adverse events contributing to death which otherwise would be undetected.
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spelling pubmed-64405912019-04-17 Contribution of adverse events to death of hospitalised patients Haukland, Ellinor Christin Mevik, Kjersti von Plessen, Christian Nieder, Carsten Vonen, Barthold BMJ Open Qual Original Article BACKGROUND: There is no standardised method to investigate death as a patient safety indicator and we need valid and reliable measurements to use adverse events contributing to death as a quality measure. OBJECTIVE: To investigate the contribution of severe adverse events to death in hospitalised patients and clarify methodological differences using the Global Trigger Tool method on all inpatient deaths compared with a sample of general hospitalised patients. METHOD: Retrospective records reviewing using the Global Trigger Tool method. RESULTS: In 0.3% of hospital admissions, adverse events contribute to inpatient death. Patients who die in hospital have twice the rate of adverse events per 1000 patient days compared with general patients, 76.7 vs 36.5 (p<0.001, RR 2.10, 95% CI 1.79 to 2.47). Patients dying in hospital experience seven times the rate of severe adverse events, 38.4% vs 5.2% (p<0.001, RR 2.10, 95% CI 1.79 to 2.47). For 86 out of 377 inpatient deaths, the adverse event is so severe that it contributes to death. 27.9% of severe adverse events contributing to death originate in primary care. Lower respiratory infections (p<0.001, RR 2.81, 95% CI 1.76 to 4.51), medication harm (p<0.001, RR 5.21, 95% CI 3.04 to 8.94) and pressure ulcers (p=0.04, RR 2.23, 95% CI 1.03 to 4.85) are significantly more frequent for inpatient deaths than in the general sample of hospital patients. CONCLUSIONS: Patients dying in hospitals experience seven times the rate of severe adverse events. Reviewing all inpatient death by the Global Trigger Tool method discloses new valid and reliable data of severe adverse events contributing to death which otherwise would be undetected. BMJ Publishing Group 2019-02-13 /pmc/articles/PMC6440591/ /pubmed/30997413 http://dx.doi.org/10.1136/bmjoq-2018-000377 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Original Article
Haukland, Ellinor Christin
Mevik, Kjersti
von Plessen, Christian
Nieder, Carsten
Vonen, Barthold
Contribution of adverse events to death of hospitalised patients
title Contribution of adverse events to death of hospitalised patients
title_full Contribution of adverse events to death of hospitalised patients
title_fullStr Contribution of adverse events to death of hospitalised patients
title_full_unstemmed Contribution of adverse events to death of hospitalised patients
title_short Contribution of adverse events to death of hospitalised patients
title_sort contribution of adverse events to death of hospitalised patients
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6440591/
https://www.ncbi.nlm.nih.gov/pubmed/30997413
http://dx.doi.org/10.1136/bmjoq-2018-000377
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