Alan J. Forster, MD, FRCPC, MSc; Harvey J. Murff, MD; Josh F. Peterson, MD; Tejal K. Gandhi, MD, MPH; David W. Bates, MD, MSc
Grant Support: By an R. Samuel McLaughlin Fellowship (Dr. Forster).
Potential Financial Conflicts of Interest:Consultancies: D.W. Bates; Honoraria: D.W. Bates.
Requests for Single Reprints: David W. Bates, MD, MSc, Division of General Medicine, Brigham and Women's Hospital, PBB-A3, 75 Francis Street, Boston, MA 02115; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Forster: University of Ottawa, F654-1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada.
Drs. Murff, Peterson, Gandhi, and Bates: Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.
Author Contributions: Conception and design: A.J. Forster, T.K. Gandhi, D.W. Bates.
Analysis and interpretation of the data: A.J. Forster, H.J. Murff, J.F. Peterson, T.K. Gandhi, D.W. Bates.
Drafting of the article: A.J. Forster.
Critical revision of the article for important intellectual content: A.J. Forster, H.J. Murff, T.K. Gandhi, D.W. Bates.
Final approval of the article: A.J. Forster, H.J. Murff, J.F. Peterson, T.K. Gandhi, D.W. Bates.
Provision of study materials or patients: A.J. Forster, D.W. Bates.
Statistical expertise: A.J. Forster, D.W. Bates.
Obtaining of funding: A.J. Forster.
Administrative, technical, or logistic support: A.J. Forster, D.W. Bates.
Collection and assembly of data: A.J. Forster.
Studies of hospitalized patients identify safety as a significant problem, but few data are available regarding injuries occurring after discharge. Patients may be vulnerable during this transition period.
To describe the incidence, severity, preventability, and ameliorability of adverse events affecting patients after discharge from the hospital and to develop strategies for improving patient safety during this interval.
Prospective cohort study.
A tertiary care academic hospital.
400 consecutive patients discharged home from the general medical service.
The three main outcomes were adverse events, defined as injuries occurring as a result of medical management; preventable adverse events, defined as adverse events judged to have been caused by an error; and ameliorable adverse events, defined as adverse events whose severity could have been decreased. Posthospital course was determined by performing a medical record review and a structured telephone interview approximately 3 weeks after each patient's discharge. Outcomes were determined by independent physician reviews.
Seventy-six patients had adverse events after discharge (19% [95% CI, 15% to 23%]). Of these, 23 had preventable adverse events (6% [CI, 4% to 9%]) and 24 had ameliorable adverse events (6% [CI, 4% to 9%]). Three percent of injuries were serious laboratory abnormalities, 65% were symptoms, 30% were symptoms associated with a nonpermanent disability, and 3% were permanent disabilities. Adverse drug events were the most common type of adverse event (66% [CI, 55% to 76%]), followed by procedure-related injuries (17% [CI, 8% to 26%]). Of the 25 adverse events resulting in at least a nonpermanent disability, 12 were preventable (48% [CI, 28% to 68%]) and 6 were ameliorable (24% [CI, 7% to 41%]).
Adverse events occurred frequently in the peridischarge period, and many could potentially have been prevented or ameliorated with simple strategies.
Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW. The Incidence and Severity of Adverse Events Affecting Patients after Discharge from the Hospital. Ann Intern Med. 2003;138:161–167. doi: 10.7326/0003-4819-138-3-200302040-00007
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Published: Ann Intern Med. 2003;138(3):161-167.
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