Adverse drug event trigger tool: a practical methodology for measuring medication related harm

Governmental designation of emergency medical institutes: 30 days mortality by types of designation

BACKGROUND

In 2000, the South Korean government introduced a program in emergency medical institutions throughout the country to establish effective management system for emergency patients. The aim of this study was is to investigate the effectiveness of this program for emergency patients and establish evidence for more effective strategy by comparing the relationship between types of emergency medical center and 30 day mortality after hospitalization in inpatients with cerebrovascular and cardiovascular diseases.

METHODS

We used National Health Insurance claim data (n = 111,741) from 115 hospitals during 2010-2013 to analyze readmissions within 30 days after hospitalization due to cerebrovascular and cardiovascular diseases. We performed χ2 tests, analysis of variance and logistic regression analysis using generalized estimating equation (GEE) modeling to investigate associations with 30 day mortality after hospitalization.

RESULTS

Deaths within 30 days of hospitalization due to cerebrovascular and cardiovascular diseases were 6.5%. Regional emergency medical center and localized emergency medical center had lower risk in 30 days mortality after hospitalization than localized emergency medical agency (regional emergency medical center = OR: 0.71, 95 CI: 0.60-0.84; localized emergency medical center = OR: 0.81, 95% CI: 0.72-0.90; ref. = localized emergency medical agency). In addition, reduction in 30 days mortality by types of emergency medical institutes was more highly associated in cerebrovascular diseases than cardiovascular diseases.

CONCLUSIONS

Government designated higher level emergency medical institutes had better outcomes in emergency medical care than localized emergency medical agencies. Thus, health policy makers have to consider optimal reimbursement in the field of emergency medicine.

Adverse events in critical care: Search and active detection through the Trigger Tool

AIM

To investigate the incidence of disadvantageous events by using the Global Trigger Tool in an intensive care unit (ICU).

METHODS

A retrospective descriptive study was performed in a 12-bed university ICU in the city of Medellin, Colombia. Clinical charts of hospitalized patients were reviewed, between January 1 and December 31, 2016, with the following inclusion criteria: subjects aged over 18 years, with at least 24 h of hospitalization and who had a complete medical history that could be accessed. Interventions: Trained reviewers conducted a retrospective examination of medical charts searching for clue events that elicit investigation, in order to detect an unfavorable event. Measurements: Information was processed through SPSS software version 21; for numerical variables, the mean was reported with standard deviation (SD). Percentages were calculated for qualitative variables.

RESULTS

Two hundred and forty-four triggers occurred, with 82.4% of subjects having presented with at least one and an average of 3.37 (SD 3.47). A total of 178 adverse events (AEs) took place in 48 individuals, with an incidence of 52.1%. On average, four events per patient were recorded, and for each unfortunate event, 1.98 triggers were presented. The most frequent displeasing issues were: pressure ulcers (17.6%), followed by complications or reactions to medical devices (4.3%), and lacerations or skin defects (3.7%); the least frequent was delayed diagnosis or treatment (0.56%). Thirty-eight point four percent of mishap events caused temporary damage that required intervention, and 48.9% of AEs were preventable. Comparison between AEs and admission diagnoses found that hypertension and sepsis were the only diagnoses that had statistical significance (P = 0.042 and 0.022, respectively).

CONCLUSION

Almost half of the unfavorable issues were classified as avoidable, which leaves a very wide field of work in terms of preventative activities.