Daumit Gail L, McGinty Emma E, Pronovost Peter, Dixon Lisa B, Guallar Eliseo, Ford Daniel E, Cahoon Elizabeth K, Boonyasai Romsai T, Thompson David
Dr. Daumit, Dr. Ford, and Dr. Boonyasai are with the Department of Internal Medicine, and Dr. Pronovost and Dr. Thompson are with the Department of Anesthesiology and the Department of Critical Care Medicine, all at Johns Hopkins University School of Medicine, Baltimore. Dr. Daumit is also with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, where Dr. McGinty is affiliated. Dr. Dixon is with the New York State Psychiatric Institute and the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City. Dr. Guallar is with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore. Dr. Cahoon is with the Radiation Epidemiology Branch, National Cancer Institute, Bethesda, Maryland. Send correspondence to Dr. McGinty (e-mail:
Psychiatr Serv. 2016 Oct 1;67(10):1068-1075. doi: 10.1176/appi.ps.201500415. Epub 2016 May 16.
This study explored the risk of patient safety events and associated nonfatal physical harms and mortality in a cohort of persons with serious mental illness. This group experiences high rates of medical comorbidity and premature mortality and may be at high risk of adverse patient safety events.
Medical record review was conducted for medical-surgical hospitalizations occurring during 1994-2004 in a community-based cohort of Maryland adults with serious mental illness. Individuals were eligible if they died within 30 days of a medical-surgical hospitalization and if they also had at least one prior medical-surgical hospitalization within five years of death. All admissions took place at Maryland general hospitals. A case-crossover analysis examined the relationships among patient safety events, physical harms, and elevated likelihood of death within 30 days of hospitalization.
A total of 790 hospitalizations among 253 adults were reviewed. The mean number of patient safety events per hospitalization was 5.8, and the rate of physical harms was 142 per 100 hospitalizations. The odds of physical harm were elevated in hospitalizations in which 22 of the 34 patient safety events occurred (p<.05), including medical events (odds ratio [OR]=1.5, 95% confidence interval [CI]=1.3-1.7) and procedure-related events (OR=1.6, CI=1.2-2.0). Adjusted odds of death within 30 days of hospitalization were elevated for individuals with any patient safety event, compared with those with no event (OR=3.7, CI=1.4-10.3).
Patient safety events were positively associated with physical harm and 30-day mortality in nonpsychiatric hospitalizations for persons with serious mental illness.
本研究探讨了患有严重精神疾病的人群中患者安全事件以及相关非致命身体伤害和死亡率的风险。该群体存在较高的医疗合并症发生率和过早死亡率，可能面临较高的患者安全不良事件风险。
对1994 - 2004年间马里兰州患有严重精神疾病的成年社区队列中因内科或外科住院治疗的病历进行回顾。若个体在内科或外科住院治疗后30天内死亡，且在死亡前五年内至少有一次之前的内科或外科住院治疗，则符合入选标准。所有入院治疗均在马里兰州的综合医院进行。采用病例交叉分析来研究患者安全事件、身体伤害与住院治疗后30天内死亡可能性增加之间的关系。
共回顾了253名成年人的790次住院治疗情况。每次住院治疗的患者安全事件平均数量为5.8起，身体伤害发生率为每100次住院治疗142起。在34起患者安全事件中有22起发生的住院治疗中，身体伤害的几率有所升高（p<0.05），包括医疗事件（优势比[OR]=1.5，95%置信区间[CI]=1.3 - 1.7）和与手术相关的事件（OR=1.6，CI=1.2 - 2.0）。与无任何患者安全事件的个体相比，发生任何患者安全事件的个体在住院治疗后30天内的调整死亡几率有所升高（OR=3.7，CI=1.4 - 10.3）。
在患有严重精神疾病的患者的非精神科住院治疗中，患者安全事件与身体伤害和30天死亡率呈正相关。
