What are the safety risks for patients undergoing treatment by multiple specialties: a retrospective patient record review study

BMC Health Services Research

Cordula Wagner¹  Maaike Langelaan¹  Martine C de Bruijne²  Rebecca J Baines² 

[1] NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands;Department of Public and Occupational Health & EMGO Institute for Health and Care Research, Vrije Universiteit Medical Center (VUmc), Amsterdam, The Netherlands

关键词: Epidemiology and detection;    Adverse events;    Measurement;    Medical error;    Hospital medicine;    Patient safety;   

Others  :  1134572
DOI  :  10.1186/1472-6963-13-497

 received in 2013-05-20, accepted in 2013-11-19,  发布年份 2013

【 摘 要 】

Background

If multiple medical specialties are involved in treatment there is a danger of increasing risks to patient safety. This is due to the need for greater co-ordination and communication with other specialties, less emergency cover for individual sub-specialties, and a drop in general care and the overview of care. This study aims to determine if the number of medical specialties treating a patient is associated with the risk of experiencing harm during hospital admission.

Methods

We performed a retrospective patient record review study using a stratified sample of 20 hospitals in the Netherlands. In each hospital 200 patient admissions were included. We related the occurrence of preventable adverse events and non-preventable adverse events to the number of specialties treating a patient through a stepwise multilevel logistic regression analysis.

Results

Compared to patients treated by only one specialty, patients treated by three or more specialties had an odds ratio of experiencing an adverse event of 3.01 (95% CI 2.09 to 4.34), and an odds ratio of experiencing a preventable adverse event of 2.78 (95% CI 1.77 to 4.37). After adding characteristics related to the patient and the type of health care, the odds ratio for non-preventable adverse events decreased to 1.46 (95% CI 0.95 to 2.26), and for preventable adverse events to 2.31 (95% CI 1.40 to 3.81). There were no large differences found between the groups relating to the causes of preventable adverse events. However, in patients treated by three or more specialties, the greater number of preventable adverse events was related to the diagnostic process.

Conclusions

The more specialties treating a patient the greater the risk of an adverse event. This finding became more pronounced for preventable adverse events than for non-preventable adverse events after corrections for the characteristics of the patient and their health care. This study highlights the importance of taking the number of specialties treating a patient into account. More research is needed to gain insight into the underlying causes of inadequate care when multiple specialties are required to treat a patient. This could result in appropriate solutions resulting in improvements to care.

【 授权许可】

   
2013 Baines et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Chowdhury MM, Dagash H, Pierro A: A systematic review of the impact of volume of surgery and specialization on patient outcome. Br J Surg 2007, 94(2):145-161.
• [2]Bilimoria KY, Phillips JD, Rock CE, Hayman A, Prystowsky JB, Bentrem DJ: Effect of surgeon training, specialization, and experience on outcomes for cancer surgery: a systematic review of the literature. Ann Surg Oncol 2009, 16(7):1799-1808.
• [3]Hashem A, Chi MT, Friedman CP: Medical errors as a result of specialization. J Biomed Inform 2003, 36(1–2):61-69.
• [4]Cook RI, Render M, Woods DD: Gaps in the continuity of care and progress on patient safety. BMJ 2000, 320(7237):791-794.
• [5]Raduma-Tomas MA, Flin R, Yule S, Williams D: Doctors’ handovers in hospitals: a literature review. BMJ Qual Saf 2011, 20(2):128-133.
• [6]Zegers M, de Bruijne MC, Wagner C, Hoonhout LH, Waaijman R, Smits M, et al.: Adverse events and potentially preventable deaths in Dutch hospitals: results of a retrospective patient record review study. Qual Saf Health Care 2009, 18(4):297-302.
• [7]Baker GR, Norton PG, Flintoft V, Blais R, Brown A, Cox J, et al.: The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. CMAJ 2004, 170(11):1678-1686.
• [8]Baines RJ, Langelaan M, de Bruijne MC, Asscheman H, Spreeuwenberg P, van de Steeg L, et al.: Changes in adverse event rates in hospitals over time: a longitudinal retrospective patient record review study. BMJ Qual Saf 2013, 22:290-298.
• [9]Leape LL, Brennan TA, Laird N, Lawthers AG, Localio AR, Barnes BA, et al.: The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. N Engl J Med 1991, 324(6):377-384.
• [10]Zegers M, de Bruijne MC, Wagner C, Groenewegen PP, Waaijman R, van der Wal G: Design of a retrospective patient record study on the occurrence of adverse events among patients in Dutch hospitals. BMC Health Serv Res 2007, 7:27. BioMed Central Full Text
• [11]van Vuren W, Shea CE, van der Schaaf TW: The development of an incident analysis tool for the medical field. Eindhoven: Eindhoven University of Technology; 1997.
• [12]Reason J: The contribution of latent human failures to the breakdown of complex systems. Philos Trans R Soc Lond B Biol Sci 1990, 327(1241):475-484.
• [13]Rasmussen J: Skills, rules and knowledge: signals, signs and symbols and other distinctions in human performance models. IEEE Trans Syst Man Cybern 1983, 13:257-266.
• [14]Twisk JWR: Applied Multilevel Analysis: a practical guide. Cambridge: Cambridge University Press; 2006.
• [15]Charlson ME, Pompei P, Ales KL, Mackenzie CR: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987, 40(5):373-383.
• [16]de Vet HC, Mokkink LB, Terwee CB, Hoekstra OS, Knol DL: Clinicians are right not to like Cohen’s κ. BMJ 2013, 346:f2125.
• [17]Higashi T, Wenger NS, Adams JL, Fung C, Roland M, McGlynn EA, et al.: Relationship between number of medical conditions and quality of care. N Engl J Med 2007, 356(24):2496-2504.
• [18]Nardi R, Scanelli G, Corrao S, Iori I, Mathieu G, Cataldi AR: Co-morbidity does not reflect complexity in internal medicine patients. Eur J Intern Med 2007, 18(5):359-368.
• [19]Symons NR, Almoudaris AM, Nagpal K, Vincent CA, Moorthy K: An observational study of the frequency, severity, and etiology of failures in postoperative care after major elective general surgery. Ann Surg 2013, 257(1):1-5.
• [20]Rabol LI, Andersen ML, Ostergaard D, Bjorn B, Lilja B, Mogensen T: Descriptions of verbal communication errors between staff. An analysis of 84 root cause analysis-reports from Danish hospitals. BMJ Qual Saf 2011, 20(3):268-274.
• [21]Wilson RM, Runciman WB, Gibberd RW, Harrison BT, Newby L, Hamilton JD: The Quality in Australian Health Care Study. Med J Aust 1995, 163(9):458-471.
• [22]Sutcliffe KM, Lewton E, Rosenthal MM: Communication failures: an insidious contributor to medical mishaps. Acad Med 2004, 79(2):186-194.
• [23]Leonard M, Graham S, Bonacum D: The human factor: the critical importance of effective teamwork and communication in providing safe care. Qual Saf Health Care 2004, 13(Suppl 1):i85-i90.
• [24]Solet DJ, Norvell JM, Rutan GH, Frankel RM: Lost in translation: challenges and opportunities in physician-to-physician communication during patient handoffs. Acad Med 2005, 80(12):1094-1099.
• [25]Bartlett G, Blais R, Tamblyn R, Clermont RJ, MacGibbon B: Impact of patient communication problems on the risk of preventable adverse events in acute care settings. CMAJ 2008, 178(12):1555-1562.
• [26]Kulaga ME, Charney P, O’Mahony SP, Cleary JP, McClung TM, Schildkamp DE, et al.: The positive impact of initiation of hospitalist clinician educators. J Gen Intern Med 2004, 19(4):293-301.
• [27]Auerbach AD, Wachter RM, Katz P, Showstack J, Baron RB, Goldman L: Implementation of a voluntary hospitalist service at a community teaching hospital: improved clinical efficiency and patient outcomes. Ann Intern Med 2002, 137(11):859-865.
• [28]Smits M, Zegers M, Groenewegen PP, Timmermans DR, Zwaan L, van der Wal G, et al.: Exploring the causes of adverse events in hospitals and potential prevention strategies. Qual Saf Health Care 2010, 19(5):e5.