Author Topic: Adverse events common among neurologic inpatients  (Read 31 times)

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Offline agate

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Adverse events common among neurologic inpatients
« on: July 18, 2017, 02:58:43 pm »
When we who have MS are unlucky enough to need hospitalization, the medical providers who deal with us seldom seem very aware of the risks faced by someone with neurological impairment. Infections develop and are raging before the proper medical care is provided. Injuries happen because of our impaired mobility. Often our hearing and/or vision or information processing skills are impaired too, and may be more impaired than usual if we are hospitalized for surgery or serious illness.

The medical profession may be starting to show more awareness of this situation. From
Neurology, June 14, 2017:

Quote
Hospital safety among neurologic patients

A population-based cohort study of adverse events

Khara M. Sauro, PhD, Hude Quan, PhD, Khokan C. Sikdar, PhD, Peter Faris, PhD and Nathalie Jette, MD, MSc

From the Department of Community Health Sciences (K.M.S., H.Q., K.C.S., N.J.), Department of Clinical Neurosciences (K.M.S., N.J.), and Hotchkiss Brain Institute (K.M.S., N.J.), Cumming School of Medicine, University of Calgary; and Alberta Health Services (P.F.), Calgary, Canada.

ABSTRACT

Objective:

To examine the frequency and type of adverse events (AEs) experienced by neurologic patients in hospital.

Methods:

This population-based, retrospective cohort study used hospital discharge abstract data for children and adults admitted to hospital from 2009 to 2015 with 1 of 9 neurologic conditions (Alzheimer disease and related dementia, brain tumor, epilepsy, motor neuron disease, multiple sclerosis, parkinsonism/Parkinson disease, spinal cord injury, traumatic brain injury, and stroke). Neurologic conditions were identified with ICD-10-CA codes. Eighteen AEs were examined with ICD-10-CA codes. The proportion of AEs was calculated, and regression analysis was used to examine factors and outcomes associated with AEs (age, sex, comorbidity, length of stay, and mortality).

Results:

The overall proportion of admissions associated with an AE among those with a neurologic condition was 11 per 100 admissions. Those with a spinal cord injury had the highest proportion of AEs (39.4 per 100 admissions). The most common AEs were infections and respiratory complications (32.0% and 16.7%, respectively). Age and the presence of comorbidities were associated with higher odds of an AE, while readmission was associated with lower odds of an AE. Having an AE was associated with increased length of stay and higher odds of mortality.

Conclusions:

This study demonstrates that neurologic patients have a high proportion of AEs in hospital. The findings provide information on the quality and safety of care for people with neurologic conditions in hospital, which can help inform future quality improvement initiatives.

http://www.neurology.org/content/89/3/284

This article has provoked some commentary in NEJM Journal Watch, July 18:

Quote
Adverse Events Are Common Among Neurologic Inpatients

John C. Probasco, MD Reviewing Sauro KM et al., Neurology 2017 Jun 14

The occurrence of adverse events in these patients is associated with in-hospital mortality and longer hospital stays.

In a healthcare environment that emphasizes high-value, high-quality, low-cost care delivery, adverse events (AEs) are a particular point of focus. Neurologic diseases are heterogeneous and particularly susceptible to variations in quality and cost of inpatient care. Understanding the frequency and type of AEs among neurologic inpatients is an important step in improving the care we deliver.

Using provincial health services data, investigators reviewed 177,612 admissions associated with 9 prespecified neurologic conditions to any of the 115 acute, subacute, psychiatric, and rehabilitation facilities in Alberta, Canada. Of these admissions, 19,595 (11%) were associated with one or more AEs. Compared with the other neurologic conditions, spinal cord injury was associated with the highest odds of an AE (odds ratio, 5.36), most often surgery-related or infectious. Stroke, Alzheimer disease and related dementia, and traumatic brain injury were also associated with increased AE occurrence (ORs, 1.31, 1.25, and 1.14, respectively). The most common AEs overall were infections (32%) and respiratory-related AEs (17%). Having an AE was associated with in-hospital mortality (OR, 2.4). Length of admission was 35.4 days longer for those with an AE than for those without.

Comment

The observations made here emphasize that neurologic inpatients are at particular risk for AEs. Of all neurologic admissions, 11% were complicated by at least one adverse event, a proportion greater than that observed among a nationwide general inpatient population in Canada (7.5% of admissions) This proportion may be even higher, as falls were not easily identified in the administrative data used in this study. Neurohospitalists and neurology-specific care teams may play important roles in mitigating the risk for AEs among neurologic inpatients. Future studies of individual AEs among specific neurologic disease populations are needed, as are focused interventions, to further improve the care we deliver.

MS Speaks--online for 13 years

SPMS, diagnosed 1980. Avonex 2001-2004. Copaxone 2007-2010.

 

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