Abstract
Objectives
High rates of adverse events (AEs) are reported for post-acute and long-term care
settings (PA/LTC: skilled nursing facilities, inpatient rehabilitation centers, long-term
acute care facilities, and home health). However, emergency department (ED)-based
studies in this area are lacking. We describe all-cause harm among patients from PA/LTC
settings seen in the ED.
Design
Retrospective observational study using the ED Trigger Tool, with dual independent
nurse reviews of 5582 ED records with triggers (findings increasing the likelihood
of an AE) and confirmatory physician review of putative AEs.
Setting and Participants
We captured data for all adult patients at an urban, academic ED over a 13-month period
(92,859 visits). PA/LTC patients were identified using a computerized ED Trigger Tool
and manual review (κ = 0.85).
Measures
We characterize the AEs identified by severity and type using the ED Taxonomy of Adverse
Events, and whether the AE occurred in the ED or was present on arrival. We estimate
population AE rates using inverse probability weighting.
Results
Compared with non-PA/LTC patients, PA/LTC patients (4.4% of population; 8.2% of our
sample) tended to be older (median age 69 vs 50 years), with comparable sex ratios
(54% female overall). PA/LTC patients accounted for 21% of all AEs (26% present on
arrival; 13% in ED). Rates of AEs occurring in the ED were comparable after matching
on age. Present on arrival AEs from a PA/LTC setting were most commonly related to
patient care (39%), medication (34%), and infections (16%).
Conclusions and Implications
PA/LTC patients account for a small proportion of ED visits but experience a disproportionate
number of AEs that are primarily present on arrival and patient-care related, and
contribute to an admission rate double that for non-PA/LTC patients. Arguably, this
cohort represents PA/LTC patients with the most severe AEs. Understanding these AEs
may help identify high-yield targets for quality improvement.
Keywords
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Article info
Publication history
Published online: August 11, 2020
Footnotes
This work was supported by the Agency for Healthcare Research and Quality
(Grant# R18 HS025052-01) and the Foundation for Barnes-Jewish Hospital (#3767).
Identification
Copyright
© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
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