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One fourth of unplanned transfers to a higher level of care are associated with a highly preventable adverse event: a patient record review in six Belgian hospitals.

Marquet K, Claes N, De Troy E, Kox G, Droogmans M, Schrooten W, Weekers F, Vlayen A, Vandersteen M, Vleugels A - Crit. Care Med. (2015)

Bottom Line: Six Belgian acute hospitals.During a 6-month period, all patients with an unplanned need for a higher level of care were selected.The level of harm varied from temporary harm (55.7%) to long-term or permanent impairment (19.1%) and death (25.2%).

View Article: PubMed Central - PubMed

Affiliation: 1Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium. 2Antwerp Management School, Health Care Management, Antwerp, Belgium. 3Vzw Jessa ziekenhuis, Hasselt, Belgium. 4Ziekenhuis Oost Limburg, Genk, Belgium. 5Algemeen Ziekenhuis Turnhout, Turnhout, Belgium. 6Center for Health Services and Nursing Research, Catholic University Leuven, Belgium.

ABSTRACT

Objective: The objectives of this study are to determine the prevalence and preventability of adverse events requiring an unplanned higher level of care, defined as an unplanned transfer to the ICU or an in-hospital medical emergency team intervention, and to assess the type and the level of harm of each adverse event.

Design: A three-stage retrospective review process of screening, record review, and consensus judgment was performed.

Setting: Six Belgian acute hospitals.

Patients: During a 6-month period, all patients with an unplanned need for a higher level of care were selected.

Interventions: The records 6-month period, the records of all patients with an unplanned need for a higher level of care were assessed by a trained clinical team consisting of a research nurse, a physician, and a clinical pharmacist.

Measurements and main results: Adverse events were found in 465 of the 830 reviewed patient records (56%). Of these, 215 (46%) were highly preventable. The overall incidence rate of patients being transferred to a higher level of care involving an adverse event was 117.6 (95% CI, 106.9-128.3) per 100,000 patient days at risk, of which 54.4 (95% CI, 47.15-61.65) per 100,000 patient days at risk involving a highly preventable adverse event. This means that 25.9% of all unplanned transfers to a higher level of care were associated with a highly preventable adverse event. The adverse events were mainly associated with drug therapy (25.6%), surgery (23.7%), diagnosis (12.4%), and system issues (12.4%). The level of harm varied from temporary harm (55.7%) to long-term or permanent impairment (19.1%) and death (25.2%). Although the direct causality is often hard to prove, it is reasonable to consider these adverse events as a contributing factor.

Conclusion: Adverse events were found in 56% of the reviewed records, of which almost half were considered highly preventable. This means that one fourth of all unplanned transfers to a higher level of care were associated with a highly preventable adverse event.

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Related in: MedlinePlus

Overview of the inclusion and review process of patients with an unplanned transfer to a higher level of care during a 6-month period. AE = adverse events, MET = medical emergency team.
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Figure 1: Overview of the inclusion and review process of patients with an unplanned transfer to a higher level of care during a 6-month period. AE = adverse events, MET = medical emergency team.

Mentions: During the 6-month observation period, 395,338 patient hospitalization days, 5,446 admissions to the ICUs, and 255 MET interventions were registered in the six participating hospitals. Seven hundred fifty-three of the transfers to intensive care (13.8%) were unplanned; 183 of these (24.3%) were readmissions to the ICU. One hundred fifteen patients received a MET intervention without transfer to intensive care. Combined, 868 patients with an unplanned need for higher level of care were included in the record review (Fig. 1), of which 515 (59.3%) were included by the two teaching hospitals. Of this initial cohort, 38 records (4.4%) were found too incomplete for the review and were excluded. Therefore, 830 patient records were reviewed. Their demographic and clinical characteristics are shown in Table 2 and in Supplement Table 2 (Supplemental Digital Content 2, http://links.lww.com/CCM/B209).


One fourth of unplanned transfers to a higher level of care are associated with a highly preventable adverse event: a patient record review in six Belgian hospitals.

Marquet K, Claes N, De Troy E, Kox G, Droogmans M, Schrooten W, Weekers F, Vlayen A, Vandersteen M, Vleugels A - Crit. Care Med. (2015)

Overview of the inclusion and review process of patients with an unplanned transfer to a higher level of care during a 6-month period. AE = adverse events, MET = medical emergency team.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4403974&req=5

Figure 1: Overview of the inclusion and review process of patients with an unplanned transfer to a higher level of care during a 6-month period. AE = adverse events, MET = medical emergency team.
Mentions: During the 6-month observation period, 395,338 patient hospitalization days, 5,446 admissions to the ICUs, and 255 MET interventions were registered in the six participating hospitals. Seven hundred fifty-three of the transfers to intensive care (13.8%) were unplanned; 183 of these (24.3%) were readmissions to the ICU. One hundred fifteen patients received a MET intervention without transfer to intensive care. Combined, 868 patients with an unplanned need for higher level of care were included in the record review (Fig. 1), of which 515 (59.3%) were included by the two teaching hospitals. Of this initial cohort, 38 records (4.4%) were found too incomplete for the review and were excluded. Therefore, 830 patient records were reviewed. Their demographic and clinical characteristics are shown in Table 2 and in Supplement Table 2 (Supplemental Digital Content 2, http://links.lww.com/CCM/B209).

Bottom Line: Six Belgian acute hospitals.During a 6-month period, all patients with an unplanned need for a higher level of care were selected.The level of harm varied from temporary harm (55.7%) to long-term or permanent impairment (19.1%) and death (25.2%).

View Article: PubMed Central - PubMed

Affiliation: 1Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium. 2Antwerp Management School, Health Care Management, Antwerp, Belgium. 3Vzw Jessa ziekenhuis, Hasselt, Belgium. 4Ziekenhuis Oost Limburg, Genk, Belgium. 5Algemeen Ziekenhuis Turnhout, Turnhout, Belgium. 6Center for Health Services and Nursing Research, Catholic University Leuven, Belgium.

ABSTRACT

Objective: The objectives of this study are to determine the prevalence and preventability of adverse events requiring an unplanned higher level of care, defined as an unplanned transfer to the ICU or an in-hospital medical emergency team intervention, and to assess the type and the level of harm of each adverse event.

Design: A three-stage retrospective review process of screening, record review, and consensus judgment was performed.

Setting: Six Belgian acute hospitals.

Patients: During a 6-month period, all patients with an unplanned need for a higher level of care were selected.

Interventions: The records 6-month period, the records of all patients with an unplanned need for a higher level of care were assessed by a trained clinical team consisting of a research nurse, a physician, and a clinical pharmacist.

Measurements and main results: Adverse events were found in 465 of the 830 reviewed patient records (56%). Of these, 215 (46%) were highly preventable. The overall incidence rate of patients being transferred to a higher level of care involving an adverse event was 117.6 (95% CI, 106.9-128.3) per 100,000 patient days at risk, of which 54.4 (95% CI, 47.15-61.65) per 100,000 patient days at risk involving a highly preventable adverse event. This means that 25.9% of all unplanned transfers to a higher level of care were associated with a highly preventable adverse event. The adverse events were mainly associated with drug therapy (25.6%), surgery (23.7%), diagnosis (12.4%), and system issues (12.4%). The level of harm varied from temporary harm (55.7%) to long-term or permanent impairment (19.1%) and death (25.2%). Although the direct causality is often hard to prove, it is reasonable to consider these adverse events as a contributing factor.

Conclusion: Adverse events were found in 56% of the reviewed records, of which almost half were considered highly preventable. This means that one fourth of all unplanned transfers to a higher level of care were associated with a highly preventable adverse event.

Show MeSH
Related in: MedlinePlus