From the Pascal Metrics PSO, Washington, District of Columbia.
J Patient Saf. 2024 Oct 1;20(7):e92-e96. doi: 10.1097/PTS.0000000000001254. Epub 2024 Jul 23.
The aims of the study were to describe inpatient harm events detected via an automatic electronic trigger system (ETS) and to consider their financial consequences.
Over a 27-month period, inpatient harm events were identified and documented in 1 healthcare system with 37 acute care facilities. Patients who experienced harm (all harm or preventable harm only) were compared with similar patients who did not. Clinical, financial, and demographic data were used to identify labor-adjusted direct variable costs (DVC) and potential differences in length of stay (LOS) associated with all-harm, preventable-harm, and nonharmed cohorts. Age-adjusted Charlson Comorbidity Index, case mix index, diagnosis-related groups, major diagnostic category, sex, age, location, diagnosis, adverse event category and subcategory, preventability, and harm severity were used to compare cohorts. Total harm events reported via the ETS and the health system's voluntary event reporting system were compared.
Nearly 93,000 encounters for all-harm (n = 25,665) and nonharmed cohorts (n = 67,217) were compared by random sampling of diagnosis-related group-matched all-harm and nonharmed groups to ensure similar clinical conditions, as measured by Charlson Comorbidity Index and case mix index. Sampling (2 groups, n = 100 and n = 200) showed that increased LOS was associated with harm; yet other clinical comparators were similar across groups. the preventable-harm subcohort had longer LOS (10.7 versus 5.9 days) and higher DVC ($13,442 versus $8024) than the nonharmed cohort. Identification of harm events was nearly 6-fold higher with the ETS than with the voluntary event reporting system.
Patients with preventable harm had increased LOS that was associated with higher DVC per preventable-harm encounter in a large US healthcare system.
本研究旨在描述通过自动电子触发系统（ETS）检测到的住院伤害事件，并考虑其经济后果。
在 27 个月的时间里，在一家拥有 37 家急性护理设施的医疗系统中，识别并记录了住院伤害事件。将经历伤害的患者（所有伤害或可预防伤害）与未经历伤害的患者进行比较。使用临床、财务和人口统计学数据来确定与所有伤害、可预防伤害和未受伤害队列相关的劳动力调整后的直接变量成本（DVC）和潜在的住院时间（LOS）差异。使用年龄调整后的 Charlson 合并症指数、病例组合指数、诊断相关组、主要诊断类别、性别、年龄、地点、诊断、不良事件类别和亚类、可预防和伤害严重程度来比较队列。通过 ETS 和医疗系统自愿事件报告系统报告的总伤害事件进行比较。
通过对诊断相关组匹配的所有伤害和未受伤害组进行随机抽样，比较了近 93000 例所有伤害（n=25665）和未受伤害队列（n=67217），以确保类似的临床条件，如 Charlson 合并症指数和病例组合指数所衡量。抽样（2 组，n=100 和 n=200）表明，LOS 增加与伤害有关；然而，其他临床比较器在各组之间相似。与未受伤害组相比，可预防伤害亚组的 LOS 更长（10.7 天对 5.9 天），DVC 更高（13442 美元对 8024 美元）。与自愿事件报告系统相比，ETS 识别伤害事件的比例几乎高出 6 倍。
在美国大型医疗保健系统中，可预防伤害患者的 LOS 增加，与每例可预防伤害事件相关的 DVC 更高。
