Inappropriate hospital admission as a risk factor for the subsequent development of adverse events: a cross-sectional study

BMC Medicine

Research Article

Paulo Sousa¹  Paloma Moreno-Nunez²  Diego San Jose-Saras³  Jesús María Aranaz-Andres⁴  Jorge Vicente-Guijarro⁴ 

[1] NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal;Preventive Medicine and Public Health Service, Hospital Universitario Ramón y Cajal, IRYCIS, 28034, Madrid, Spain;Faculty of Health Sciences, Universidad Internacional de La Rioja, 26006, Logroño, La Rioja, Spain;Preventive Medicine and Public Health Service, Hospital Universitario Ramón y Cajal, IRYCIS, 28034, Madrid, Spain;Universidad de Alcalá, School of Medicine and Health Sciences, Department of Medicine and Medical Specialities, Alcalá de Henares, Spain;Preventive Medicine and Public Health Service, Hospital Universitario Ramón y Cajal. IRYCIS. CIBER of Epidemiology and Public Health (CIBERESP), 28034, Madrid, Spain;Faculty of Health Sciences, Universidad Internacional de La Rioja, 26006, Logroño, La Rioja, Spain;

关键词: Appropriateness of health care;    Inappropriate hospital admission;    Patient safety;    Adverse events;   

DOI  :  10.1186/s12916-023-03024-0

 received in 2023-05-08, accepted in 2023-08-07,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundAll health overuse implies an unnecessary risk of patients suffering adverse events (AEs). However, this hypothesis has not been corroborated by direct estimates for inappropriate hospital admission (IHA). The objectives of the study were the following: (1) to analyze the association between IHA and the development of subsequent AEs; (2) to explore the distinct clinical and economic implications of AEs subsequent IHA compared to appropriate admissions.MethodsAn observational cross-sectional study was conducted on hospitalized patients in May 2019 in a high-complexity hospital in Madrid, Spain. The Appropriateness Evaluation Protocol was used to measure IHA, and the methodologies of the Harvard Medical Practice Study and the European Point Prevalence Survey of Healthcare-associated Infections were used to detect and characterize AEs. The association between IHA and the subsequent.ResultsA total of 558 patients in the hospital ward were studied. IHA increased the risk of subsequent occurrence of AEs (OR [95% CI]: 3.54 [1.87 to 6.69], versus appropriate) and doubled the mean AEs per patient (coefficient [95% CI]: 0.19 [0.08 to 0.30] increase, versus appropriate) after adjusting for confounders. IHA was a predictive variable of subsequent AEs and the number of AEs per patient. AEs developed after IHA were associated with scheduled admissions (78.9% of AEs, versus 27.9% after appropriate admissions; p < 0.001). Compared with AEs developed after appropriate admissions, AEs after IHA added 2.4 additional days of stay in the intensive care unit and incurred an extra cost of €166,324.9 for the studied sample.ConclusionsPatients with IHA have a higher risk of subsequent occurrence of AE. Due to the multifactorial nature of AEs, IHA is a possible contributing factor. AEs developed after IHA are associated with scheduled admissions, prolonged ICU stays, and resulted in significant cost overruns.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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