Adverse Events After Hospital Discharge

7/23/2019 Adverse Events After Hospital Discharge

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Adverse Events after Hospital Discharge

Background

Being discharged from the hospital can be dangerous. A classic studyfound that nearly 20% of patients

experience adverse events ithin ! ee"s of discharge# nearly three$uarters of hich could have been prevented

or ameliorated. Adverse drug events are the most common postdischarge complication# ithhospital$acuired

infectionsand procedural complications also causing considerable morbidity. &ore subtle discharge ha'ards arise

from the fact that nearly (0% of patients are discharged ith test results pending# and a comparable proportion

are discharged ith a plan to complete the diagnostic or"upas an outpatient# placing patients at ris" unless

timely and complete follo$up is ensured. As nearly 20% of &edicare patients are rehospitali'edithin !0 days of

discharge# minimi'ing post$discharge adverse events has become a priority for the )* health care system.

*ystematic problems in care transitions are at the root of most adverse events that arise after discharge.

Discontinuity beteen inpatient and outpatient providers is common# and studieshave shon that traditional

communication systems +such as the dictated discharge summary, generally fail to reach outpatient providers in a

timely fashion and often lac" essential information. -atients freuently receive ne medications or havemedications changed during hospitali'ations. ac" of medication reconciliationresults in the potential for

inadvertent medication discrepanciesand adverse drug events/particularly for patients ith lo health literacy# or

those prescribed high$ris" medications or complex medication regimens.

Source:ornish -# 1noles *# &archesano # et al. )nintended medication discrepancies at the time of hospital

admission. Arch 3ntern &ed. 200456748(2($(29. :go to -ub&ed;

Even if communication beteen providers istimely and accurate# and appropriate steps are ta"en to ensure

medication safety# patients and their families still assume a large burdenof care after discharge. Accurately

assessing patients< abilities to care for themselves after discharge can be difficult and reuires a coordinated
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multidisciplinary effort. =ailure to enlist appropriate resources to help ith the transition from hospital to home +or

another health care setting, may leave patients vulnerable. =inally# the fragmented nature of the health care

system may limit individual hospitals< incentive to improve their discharge process# despite the benefits to patients

that may result.

Preventing Adverse Events after Discharge

Ensuring safe care transitions reuires a systematic approach. >hree "ey areas must be addressed prior todischarge8

&edication reconciliation8 >he patienthere is considerable interest in harnessing the poer of chec"liststo standardi'e the discharge process#

and electronic health recordsoffer great potential for improving information transfer beteen inpatient and

outpatient physicians and developing standardi'ed discharge instructions for patients.

Evaluating the magnitude of care transition problems and the effect of interventions is hampered by the lac" of a

standard outcome measurement. Hospital readmission rates are often used# but most adverse events after

discharge cause patient harm ithout reuiring readmission. A three$item patient survey measurehas been

developed to measure patient satisfaction ith the transition process5 hospitals are being encouraged to add these

items to standard patient satisfaction uestionnaires.

Current Context

A variety of policy initiatives have been implemented in order to encourage hospitals to address adverse events

and readmissions after discharge. >he enters for &edicare and &edicaid *ervices began publicly reporting

hospital readmission rates for certain conditions in 2009. >he -atient -rotection and Affordable are Act of 2060

contains multiple payment reforms intended to promote hospital efforts to address and prevent adverse events

after discharge. hief among these are financial penalties for hospitals ith above$average readmission rates for

target illnesses. *ince those penalties ere implemented in 2062# more than 2200 hospitals had up to 2% of their

annual &edicare reimbursements ithheld due to excess readmissions. Hospitals no also receive bundled

payments for target illnesses that cover all costs associated ith patient care for a !0$day period# providing a

financial incentive to ensure continuity of care.

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SEIPS Short Course on Human Factors Engineering and Patient Safety

enter for Cuality and -roductivity 3mprovement5 ollege of Engineering at the )niversity of isconsinG&adison.

uly 6!G6I# 20645 oell enter# )niversity of isconsinG&adison# &adison# 3.

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Pro!ect "edDE#: "educing Diagnostic Errors in Primary Care Pediatrics

American Academy of -ediatrics.

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Safe use of hea$th information techno$ogy

*entinel Event Alert. &arch !6# 20645+4(,86$7.

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A co$$a%orative $earning net&ork a''roach to im'rovement: the C(SP $earning net&ork

eaver *# ofthus # *ayer et al. t omm Cual -atient *af. 20645(686(I$649.

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Ana$ysis of IS)P *ationa$ +accine Errors "e'orting Program,Part - and Part .

3*&- &edication *afety AlertL Acute are Edition. December (# 206(56986$7. &arch 27# 206452086$(.

*>)DK

Sustaina%i$ity and $ong/term effectiveness of the 0H1 surgica$ safety check$ist com%ined &ith 'u$se

oximetry in a resource/$imited setting: t&o/year u'date from )o$dova

1im K# 1a"ye # 1o" A# et al. A&A *urg. 2064 &ar 245 :Epub ahead of print;.

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Deve$o'ment of an instrument to measure the unintended conse2uences of EH"s

arrington ephart * Merran A# =inley BA. est ?urs es. 2064 &ar 225 :Epub ahead of print;.

Mie all AHC -*?et resources on Adverse Events after Hospital Discharge

Editor


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Factors contri%uting to a$$/cause 67/day readmissions: a structured case series across -8

hos'ita$s

=eigenbaum -# ?euirth E# >robridge # et al. &ed are. 20625408499$704.

Ade2uacy of hos'ita$ discharge summaries in documenting tests &ith 'ending resu$ts and

out'atient fo$$o&/u' 'roviders

ere i P# 1esterson # et al. en 3ntern &ed. 200952(86002$6007.

A reengineered hos'ita$ discharge 'rogram to decrease rehos'ita$i9ation: a randomi9ed tria$

ac" B# hetty M1# Anthony D# et al. Ann 3ntern &ed. 2009564086IO$6OI.

3ying u' $oose ends: discharging 'atients &ith unreso$ved medica$ issues

&oore # &cinn ># Halm E. Arch 3ntern &ed. 200I567I86!04$6!66.

Deficits in communication and information transfer %et&een hos'ita$/%ased and 'rimary care

'hysicians: im'$ications for 'atient safety and continuity of care

1ripalani *# e=evre =# -hillips # illiams &M# Basaviah -# Ba"er D. A&A. 200I529I8O!6$O(6.

3he care transitions intervention: resu$ts of a randomi9ed contro$$ed tria$

oleman EA# -arry # halmers *# &in *. Arch 3ntern &ed. 2007567786O22$6O2O.

Posthos'ita$ medication discre'ancies: 'reva$ence and contri%uting factors

oleman EA# *mith D# aha D# &in *. Arch 3ntern &ed. 2004567486O(2$6O(I.

Patient safety concerns arising from test resu$ts that return after hos'ita$ discharge

oy # -oon E# 1arson A*# et al. Ann 3ntern &ed. 200456(!8626$62O.

3he incidence and severity of adverse events affecting 'atients after discharge from the

hos'ita$

=orster A# &urff H# -eterson =# andhi >1# Bates D. Ann 3ntern &ed. 200!56!O8676$67I.

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*ationa$ Patient Safety oa$s

a"broo" >errace# 38 >he oint ommission5 2064.

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Aftercare ti's for 'atients checking out of the hos'ita$

Alderman . ?e Kor" >imes. une 6O# 20605B7.

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Safety as ;ou o from Hos'ita$ to Home

&cean# MA8 ?ational -atient *afety =oundation.
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Care 3ransitions Program

Aurora# 8 >he Division of Health are -olicy and esearch# )niversity of olorado Health *ciences enter.

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"e/Engineered Discharge

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Adverse Events After Hospital Discharge