OBJECTIVE: To describe the incidence of adverse drug events (ADEs), preventable ADEs, and ameliorable ADEs occurring after hospital discharge and their associated risk factors. DESIGN: Prospective cohort study. SETTING: Urban academic health sciences center. PATIENTS: Consecutive patients discharged home from the general medical service. INTERVENTIONS: We determined posthospital outcomes approximately 24 days following discharge by performing a chart review and telephone interview. Using the telephone interview, we identified new or worsening symptoms, the patient's health system use, and recollection of processes of care. Posthospital outcomes were judged by 2 internists independently. RESULTS: Four hundred of 581 potentially eligible patients were evaluated. Of the 400 patients, 45 developed an ADE (incidence, 11%; 95% confidence interval [CI], 8% to 14%). Of these, 27% were preventable and 33% were ameliorable. Injuries were significant in 32 patients, serious in 6, and life threatening in 7. Patients were less likely to experience an ADE if they recalled having side effects of prescribed medications explained (OR, 0.4; 95% CI, 0.2 to 0.8). The risk of ADE per prescription was highest for corticosteroids, anticoagulants, antibiotics, analgesics, and cardiovascular medications. Risk increased with prescription number. Failure to monitor was an especially common cause of preventable and ameliorable ADEs. CONCLUSION: Following discharge, ADEs were common and many were preventable or ameliorable. Medication side effects should be discussed, and interventions should include better monitoring and target patients receiving specific drug classes or multiple medications.
OBJECTIVE: To describe the incidence of adverse drug events (ADEs), preventable ADEs, and ameliorable ADEs occurring after hospital discharge and their associated risk factors. DESIGN: Prospective cohort study. SETTING: Urban academic health sciences center. PATIENTS: Consecutive patients discharged home from the general medical service. INTERVENTIONS: We determined posthospital outcomes approximately 24 days following discharge by performing a chart review and telephone interview. Using the telephone interview, we identified new or worsening symptoms, the patient's health system use, and recollection of processes of care. Posthospital outcomes were judged by 2 internists independently. RESULTS: Four hundred of 581 potentially eligible patients were evaluated. Of the 400 patients, 45 developed an ADE (incidence, 11%; 95% confidence interval [CI], 8% to 14%). Of these, 27% were preventable and 33% were ameliorable. Injuries were significant in 32 patients, serious in 6, and life threatening in 7. Patients were less likely to experience an ADE if they recalled having side effects of prescribed medications explained (OR, 0.4; 95% CI, 0.2 to 0.8). The risk of ADE per prescription was highest for corticosteroids, anticoagulants, antibiotics, analgesics, and cardiovascular medications. Risk increased with prescription number. Failure to monitor was an especially common cause of preventable and ameliorable ADEs. CONCLUSION: Following discharge, ADEs were common and many were preventable or ameliorable. Medication side effects should be discussed, and interventions should include better monitoring and target patients receiving specific drug classes or multiple medications.
Authors: Jerry H Gurwitz; Terry S Field; Leslie R Harrold; Jeffrey Rothschild; Kristin Debellis; Andrew C Seger; Cynthia Cadoret; Leslie S Fish; Lawrence Garber; Michael Kelleher; David W Bates Journal: JAMA Date: 2003-03-05 Impact factor: 56.272
Authors: Tejal K Gandhi; Saul N Weingart; Joshua Borus; Andrew C Seger; Josh Peterson; Elisabeth Burdick; Diane L Seger; Kirstin Shu; Frank Federico; Lucian L Leape; David W Bates Journal: N Engl J Med Date: 2003-04-17 Impact factor: 91.245
Authors: Jonathan S Lee; Anna Nápoles; Sunita Mutha; Eliseo J Pérez-Stable; Steven E Gregorich; Jennifer Livaudais-Toman; Leah S Karliner Journal: Patient Educ Couns Date: 2017-07-24
Authors: Amna Al-Hashar; Ibrahim Al-Zakwani; Tommy Eriksson; Alaa Sarakbi; Badriya Al-Zadjali; Saif Al Mubaihsi; Mohammed Al Za'abi Journal: Int J Clin Pharm Date: 2018-05-12
Authors: Andrew D Auerbach; Sunil Kripalani; Eduard E Vasilevskis; Neil Sehgal; Peter K Lindenauer; Joshua P Metlay; Grant Fletcher; Gregory W Ruhnke; Scott A Flanders; Christopher Kim; Mark V Williams; Larissa Thomas; Vernon Giang; Shoshana J Herzig; Kanan Patel; W John Boscardin; Edmondo J Robinson; Jeffrey L Schnipper Journal: JAMA Intern Med Date: 2016-04 Impact factor: 21.873
Authors: Jennifer R Pippins; Tejal K Gandhi; Claus Hamann; Chima D Ndumele; Stephanie A Labonville; Ellen K Diedrichsen; Marcy G Carty; Andrew S Karson; Ishir Bhan; Christopher M Coley; Catherine L Liang; Alexander Turchin; Patricia C McCarthy; Jeffrey L Schnipper Journal: J Gen Intern Med Date: 2008-06-19 Impact factor: 5.128