Sara W Cullen1, Ming Xie2, Jentien M Vermeulen3, Steven C Marcus1. 1. School of Social Policy and Practice. 2. School of Medicine, University of Pennsylvania, Philadelphia, PA. 3. Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Abstract
OBJECTIVE: There is limited knowledge about how general hospitals and Veterans Health Administration (VHA) hospitals fare relative to each other on a broad range of inpatient psychiatry-specific patient safety outcomes.This research compares data from 2 large-scale epidemiological studies of adverse events (AEs) and medical errors (MEs) in inpatient psychiatric units, one in VHA hospitals and the other in community-based general hospitals. METHOD: Retrospective medical record reviews assessed the prevalence of AEs and MEs in a sample of 4371 discharges from 14 community-based general hospitals (derived from 69,081 discharges at 85 hospitals) and a sample of 8005 discharges from 40 VHA hospitals (derived from 92,103 discharges at 105 medical centers). Rates of AEs and MEs across hospital systems were calculated, controlling for relevant patient and hospital characteristics. RESULTS: The overall rate of AEs and MEs in inpatient psychiatric units of VHA hospitals was 7.11 and 1.49 per 100 patient discharges; at community-based acute care hospitals, these rates were 13.48 and 3.01 per 100 patient discharges. The adjusted odds ratio of a patient experiencing an AE and a ME at community-based hospitals as compared with VHA hospitals was 2.11 and 2.08, respectively. CONCLUSION: Although chart reviews may not document the complete nature and outcomes of care, even after controlling for differences in patient and hospital characteristics, psychiatric inpatients at community-based hospitals were twice as likely to experience AEs or MEs as inpatients at VHA hospitals. While community-based hospitals may lag behind VHA hospitals, both hospital systems should continue to pursue evidence-based improvements in patient safety. Future research aimed at changing hospital practices should draw on established strategies for bridging the gap from research to practice in order to improve the quality of care for this vulnerable patient population.
OBJECTIVE: There is limited knowledge about how general hospitals and Veterans Health Administration (VHA) hospitals fare relative to each other on a broad range of inpatient psychiatry-specific patient safety outcomes.This research compares data from 2 large-scale epidemiological studies of adverse events (AEs) and medical errors (MEs) in inpatient psychiatric units, one in VHA hospitals and the other in community-based general hospitals. METHOD: Retrospective medical record reviews assessed the prevalence of AEs and MEs in a sample of 4371 discharges from 14 community-based general hospitals (derived from 69,081 discharges at 85 hospitals) and a sample of 8005 discharges from 40 VHA hospitals (derived from 92,103 discharges at 105 medical centers). Rates of AEs and MEs across hospital systems were calculated, controlling for relevant patient and hospital characteristics. RESULTS: The overall rate of AEs and MEs in inpatient psychiatric units of VHA hospitals was 7.11 and 1.49 per 100 patient discharges; at community-based acute care hospitals, these rates were 13.48 and 3.01 per 100 patient discharges. The adjusted odds ratio of a patient experiencing an AE and a ME at community-based hospitals as compared with VHA hospitals was 2.11 and 2.08, respectively. CONCLUSION: Although chart reviews may not document the complete nature and outcomes of care, even after controlling for differences in patient and hospital characteristics, psychiatric inpatients at community-based hospitals were twice as likely to experience AEs or MEs as inpatients at VHA hospitals. While community-based hospitals may lag behind VHA hospitals, both hospital systems should continue to pursue evidence-based improvements in patient safety. Future research aimed at changing hospital practices should draw on established strategies for bridging the gap from research to practice in order to improve the quality of care for this vulnerable patient population.
Authors: R W Haley; D R Schaberg; D K McClish; D Quade; K B Crossley; D H Culver; W M Morgan; J E McGowan; R H Shachtman Journal: Am J Epidemiol Date: 1980-05 Impact factor: 4.897
Authors: E J Thomas; D M Studdert; H R Burstin; E J Orav; T Zeena; E J Williams; K M Howard; P C Weiler; T A Brennan Journal: Med Care Date: 2000-03 Impact factor: 2.983
Authors: Joanne Timmel; Paula S Kent; Christine G Holzmueller; Lori Paine; Richard D Schulick; Peter J Pronovost Journal: Jt Comm J Qual Patient Saf Date: 2010-06
Authors: Christopher P Landrigan; Gareth J Parry; Catherine B Bones; Andrew D Hackbarth; Donald A Goldmann; Paul J Sharek Journal: N Engl J Med Date: 2010-11-25 Impact factor: 91.245
Authors: T A Brennan; L L Leape; N M Laird; L Hebert; A R Localio; A G Lawthers; J P Newhouse; P C Weiler; H H Hiatt Journal: N Engl J Med Date: 1991-02-07 Impact factor: 91.245