TY - JOUR
T1 - Adverse Events Present on Arrival to the Emergency Department
T2 - The ED as a Dual Safety Net
AU - Griffey, Richard T.
AU - Schneider, Ryan M.
AU - Todorov, Alexandre A.
N1 - Funding Information:
This work is supported by grant R18 HS025052-01 (Griffey PI) from the Agency for Healthcare Research and Quality.
Publisher Copyright:
© 2019 The Joint Commission
PY - 2020/4
Y1 - 2020/4
N2 - Background: The emergency department (ED) is the natural venue for the provision of acute unscheduled care. However, little is known about the nature and proportion of this care that goes to addressing adverse events (AEs)—physical injury to a patient due to health care that requires some intervention—that are present on arrival (POA) to the ED. Described here are AEs that are POA, and population prevalence estimates for these events. Methods: This retrospective observational study tested the ED Trigger Tool, using data from an urban academic medical center. Patients aged ≥18 completing an ED visit were eligible (N = 92,859). A total of 5,582 visits with triggers (findings that increase the likelihood of an AE) were reviewed using the two-tier trigger approach. AEs were categorized by severity, type, and whether they were POA. POA AEs, and sociodemographic and trigger associations with AEs are described. Results: Of 1,181 AEs identified, 718 (60.8%) were POA to the ED. Patients with POA AEs were more often white (51.1% vs. 39.7%, p < 0.001) and older (median age 62 vs. 50, p < 0.001). The majority of POA AEs were medication-related and patient care–related events. In the population at this center, POA AEs account for an estimated 7.6% of ED visits (95% confidence interval = 6.9%–8.2%). Conclusion: In this single-center study, the majority of AEs detected using the ED Trigger Tool were POA. These findings highlight the importance of the ED as a safety net for harm occurring across the health system.
AB - Background: The emergency department (ED) is the natural venue for the provision of acute unscheduled care. However, little is known about the nature and proportion of this care that goes to addressing adverse events (AEs)—physical injury to a patient due to health care that requires some intervention—that are present on arrival (POA) to the ED. Described here are AEs that are POA, and population prevalence estimates for these events. Methods: This retrospective observational study tested the ED Trigger Tool, using data from an urban academic medical center. Patients aged ≥18 completing an ED visit were eligible (N = 92,859). A total of 5,582 visits with triggers (findings that increase the likelihood of an AE) were reviewed using the two-tier trigger approach. AEs were categorized by severity, type, and whether they were POA. POA AEs, and sociodemographic and trigger associations with AEs are described. Results: Of 1,181 AEs identified, 718 (60.8%) were POA to the ED. Patients with POA AEs were more often white (51.1% vs. 39.7%, p < 0.001) and older (median age 62 vs. 50, p < 0.001). The majority of POA AEs were medication-related and patient care–related events. In the population at this center, POA AEs account for an estimated 7.6% of ED visits (95% confidence interval = 6.9%–8.2%). Conclusion: In this single-center study, the majority of AEs detected using the ED Trigger Tool were POA. These findings highlight the importance of the ED as a safety net for harm occurring across the health system.
UR - http://www.scopus.com/inward/record.url?scp=85078791729&partnerID=8YFLogxK
U2 - 10.1016/j.jcjq.2019.12.003
DO - 10.1016/j.jcjq.2019.12.003
M3 - Article
C2 - 32007399
AN - SCOPUS:85078791729
SN - 1553-7250
VL - 46
SP - 192
EP - 198
JO - Joint Commission Journal on Quality and Patient Safety
JF - Joint Commission Journal on Quality and Patient Safety
IS - 4
ER -