Document Detail


Adverse events among patients registered in high-acuity areas of the emergency department: a prospective cohort study.
MedLine Citation:
PMID:  20880432     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To enhance patient safety, it is important to understand the frequency and causes of adverse events (defined as unintended injuries related to health care management). We performed this study to describe the types and risk of adverse events in high-acuity areas of the emergency department (ED).
METHODS: This prospective cohort study examined the outcomes of consecutive patients who received treatment at 2 tertiary care EDs. For discharged patients, we conducted a structured telephone interview 14 days after their initial visit; for admitted patients, we reviewed the inpatient charts. Three emergency physicians independently adjudicated flagged outcomes (e.g., death, return visits to the ED) to determine whether an adverse event had occurred.
RESULTS: We enrolled 503 patients; one-half (n = 254) were female and the median age was 57 (range 18-98) years. The majority of patients (n = 369, 73.3%) were discharged home. The most common presenting complaints were chest pain, generalized weakness and abdominal pain. Of the 107 patients with flagged outcomes, 43 (8.5%, 95% confidence interval 8.1%-8.9%) were considered to have had an adverse event through our peer review process, and over half of these (24, 55.8%) were considered preventable. The most common types of adverse events were as follows: management issues (n = 18, 41.9%), procedural complications (n = 13, 30.2%) and diagnostic issues (n = 10, 23.3%). The clinical consequences of these adverse events ranged from minor (urinary tract infection) to serious (delayed diagnosis of aortic dissection).
CONCLUSION: We detected a higher proportion of preventable adverse events compared with previous inpatient studies and suggest confirmation of these results is warranted among a wider selection of EDs.
Authors:
Lisa Anne Calder; Alan Forster; Melanie Nelson; Jason Leclair; Jeffrey Perry; Christian Vaillancourt; Guy Hebert; Adam Cwinn; George Wells; Ian Stiell
Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  CJEM     Volume:  12     ISSN:  1481-8035     ISO Abbreviation:  CJEM     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-30     Completed Date:  2011-02-03     Revised Date:  2011-10-05    
Medline Journal Info:
Nlm Unique ID:  100893237     Medline TA:  CJEM     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  421-30     Citation Subset:  IM    
Affiliation:
Department of Emergency Medicine, University of Ottawa, Ontario, Canada. lcalder@ohri.ca
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Chi-Square Distribution
Emergency Service, Hospital / standards*
Female
Humans
Logistic Models
Male
Medical Errors / classification*
Middle Aged
Ontario
Prospective Studies
Risk Assessment
Safety Management

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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