Impact of patient communication problems on the risk of preventable adverse events in acute care settings
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- 3 June 2008
- journal article
- Published by CMA Impact Inc. in CMAJ : Canadian Medical Association Journal
- Vol. 178 (12), 1555-1562
- https://doi.org/10.1503/cmaj.070690
Abstract
Background: Up to 50% of adverse events that occur in hospitals are preventable. Language barriers and disabilities that affect communication have been shown to decrease quality of care. We sought to assess whether communication problems are associated with an increased risk of preventable adverse events. Methods: We randomly selected 20 general hospitals in the province of Quebec with at least 1500 annual admissions. Of the 145 672 admissions to the selected hospitals in 2000/01, we randomly selected and reviewed 2355 charts of patients aged 18 years or older. Reviewers abstracted patient characteristics, including communication problems, and details of hospital admission, and assessed the cause and preventability of identified adverse events. The primary outcome was adverse events. Results: Of 217 adverse events, 63 (29%) were judged to be preventable, for an overall population rate of 2.7% (95% confidence interval [CI] 2.1%–3.4%). We found that patients with preventable adverse events were significantly more likely than those without such events to have a communication problem (odds ratio [OR] 3.00; 95% CI 1.43–6.27) or a psychiatric disorder (OR 2.35; 95% CI 1.09–5.05). Patients who were admitted urgently were significantly more likely than patients whose admissions were elective to experience an event (OR 1.64, 95% CI 1.07–2.52). Preventable adverse events were mainly due to drug errors (40%) or poor clinical management (32%). We found that patients with communication problems were more likely than patients without these problems to experience multiple preventable adverse events (46% v. 20%; p = 0.05). Interpretation: Patients with communication problems appeared to be at highest risk for preventable adverse events. Interventions to reduce the risk for these patients need to be developed and evaluated.Keywords
This publication has 38 references indexed in Scilit:
- Improving patient safety: moving beyond the "hype" of medical errorsCMAJ : Canadian Medical Association Journal, 2005
- Prospective association of anxiety, depressive, and addictive disorders with high utilization of primary, specialty and emergency medical careSocial Science & Medicine (1982), 2004
- Ottawa Hospital Patient Safety Study: incidence and timing of adverse events in patients admitted to a Canadian teaching hospitalCMAJ : Canadian Medical Association Journal, 2004
- Preventable in-hospital medical injury under the "no fault" system in New ZealandQuality and Safety in Health Care, 2003
- Half the families of intensive care unit patients experience inadequate communication with physiciansCritical Care Medicine, 2000
- Epidemiology of medical errorBMJ, 2000
- Redefining the Survival of the Fittest: Communication Disorders in the 21st CenturyThe Laryngoscope, 2000
- Impairment, disability and handicap as risk factors for depression in old age. The Gospel Oak Project VPsychological Medicine, 1997
- A new method of classifying prognostic comorbidity in longitudinal studies: Development and validationJournal of Chronic Diseases, 1987
- Longitudinal data analysis using generalized linear modelsBiometrika, 1986