From the Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam.
Netherlands Institute for Health Services Research (NIVEL), Utrecht.
J Patient Saf. 2021 Apr 1;17(3):166-173. doi: 10.1097/PTS.0000000000000727.
Acute care crowding is a global issue, jeopardizing patient safety. An important cause of crowding is the growing number of older, vulnerable, and complex patients. This group is at higher risk of experiencing (preventable) adverse events (AEs) than younger patients.This study aimed to identify the incidence, preventability, nature, and prevention strategies of AEs in older patients during an acute hospital admission and to assess changes over time.
We analyzed data of 4292 acutely admitted patients (70+) who died in the hospital, using data of a multicenter Dutch AE record review study (2008, 2012, 2016). Multilevel logistic regression analyses were performed to adjust for patient-mix differences and clustering on department/hospital level per year.
The incidence of AEs in this group declined significantly (χ2(1) = 8.78, P = 0.003) from 10.7% (95% confidence interval [CI] =8.2-13.9) in 2008, 7.4% (95% CI = 5.6-9.7) in 2012, to 7.2% (95% CI = 5.5-9.3) in 2016. The relative preventability showed a significant parabolic trend (χ2(1) = 4.86, P = 0.027), from 46.2% (95% CI = 34.1-58.7), to 32.4% (95% CI = 21.1-46.1), to 44.6% (95% CI = 32-58). Adverse events were often related to medication (26.3% in 2008, 35.1% in 2012, and 39.5% in 2016), and the preventability in AEs related to diagnosis was highest (88.3%, 70.8%, and 79.9%).
The incidence of AEs in older acutely admitted patients declined over the years; however, the preventability increased again after an initial decline. This could be related to crowding or increasing complexity in the acute care chain. Further monitoring and improvement in (preventable) AE rates are necessary to pinpoint areas of improvement to make hospital care for this vulnerable group safer.
急性护理拥挤是一个全球性问题，危及患者安全。拥挤的一个重要原因是越来越多的老年、脆弱和复杂的患者。与年轻患者相比，这一群体经历（可预防的）不良事件（AE）的风险更高。本研究旨在确定急性住院期间老年患者 AE 的发生率、可预防性、性质和预防策略，并评估随时间的变化。
我们分析了在荷兰多中心 AE 记录回顾研究（2008 年、2012 年、2016 年）中死亡的 4292 名急性入院（70 岁以上）患者的数据。使用多水平逻辑回归分析来调整每年患者组合差异和部门/医院水平的聚类。
该组 AE 的发生率显著下降（χ2(1) = 8.78，P = 0.003），从 2008 年的 10.7%（95%置信区间 [CI] =8.2-13.9）、2012 年的 7.4%（95% CI = 5.6-9.7）降至 2016 年的 7.2%（95% CI = 5.5-9.3）。相对可预防率呈明显抛物线趋势（χ2(1) = 4.86，P = 0.027），从 46.2%（95% CI = 34.1-58.7）降至 32.4%（95% CI = 21.1-46.1），再升至 44.6%（95% CI = 32-58）。不良事件通常与药物有关（2008 年为 26.3%，2012 年为 35.1%，2016 年为 39.5%），与诊断相关的 AE 可预防率最高（88.3%、70.8%和 79.9%）。
在过去几年中，老年急性入院患者 AE 的发生率有所下降；然而，在最初下降后，可预防率再次上升。这可能与急性护理链中的拥挤或复杂性增加有关。为了使这一脆弱群体的医院护理更加安全，有必要进一步监测和改善（可预防的）AE 发生率，以确定需要改进的领域。
