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Patient safety events in hospital care of individuals with epilepsy
Author(s) -
Mendizabal Adys,
Thibault Dylan P.,
Willis Allison W.
Publication year - 2016
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/epi.13440
Subject(s) - medicine , odds ratio , deep vein , pulmonary embolism , emergency medicine , perioperative , epilepsy , population , venous thrombosis , logistic regression , pediatrics , thrombosis , surgery , psychiatry , environmental health
Summary Objectives (1) To describe patient adverse events ( PAE s) experienced by hospitalized individuals with epilepsy and examine the association of an epilepsy diagnosis on risk of specific PAE s; (2) to examine the impact of a PAE on (a) length of stay ( LOS ), (b) inpatient death, and (c) use of institutional post‐acute care. Methods We applied the Agency for Healthcare Research and Quality ( AHRQ ) Patient Safety Indicator ( PSI ) software to the National Inpatient Sample database to identify potential medical and postoperative PAE s among >72 million hospitalizations of adults in the United States from 2000 to 2010. Logistic regression models compared the odds of experiencing each PAE between hospitalizations of persons with epilepsy ( PWE ) and the general inpatient population. We also examined the impact of experiencing a PAE on LOS , inpatient death, and discharge disposition. Results Hospitalized PWE s were at increased risk for specific postoperative PAE s: fall with hip fracture (Adjusted Odds Ratio, AOR 1.90, 1.21–2.99), respiratory failure ( AOR 2.64, 2.43–2.87), sepsis ( AOR 1.41, 1.21–1.63), and preventable postoperative death ( AOR 1.25, 1.15–1.36). The odds of perioperative pulmonary embolism/deep vein thrombosis ( AOR 1.65, 1.57–1.73), skin pressure ulcer ( AOR 1.25, 1.22–1.29), and central venous catheter‐related bloodstream infections ( AOR 1.24, 1.17–1.32) were also greater among hospitalizations of PWE s. Experiencing a PAE was associated with a prolonged mean length of stay (15 days vs. 5 days, t ‐test p < 0.001), a 416% increase in the odds of inpatient death ( AOR 4.16, 3.95–4.38), and a 282% increase in use of high‐level post‐acute care ( AOR 2.82, 2.72–2.93). Significance Hospitalized adults with epilepsy are vulnerable to specific safety‐related adverse events, and these potential patient safety failures substantially impact outcomes and resource use. Efforts to reduce long‐term disability and improve the value of care delivered to PWE s may need to consider provider‐level interventions to reduce adverse events.