August 23, 2019
Getting an infection while in hospital, having an adverse reaction to a medication, or even worse, having something left inside you after surgery are all examples of adverse events that patients are at risk of experiencing during a hospital stay. In 2015, The Canadian Institute for Health Information (CIHI), in partnership with the Canadian Patient Safety Institute (CPSI), created a measuring tool that identified these types of adverse events (termed ‘hospital harm’) using hospital discharge data.
Now, researchers from Dalla Lana School of Public Health’s Institute of Health Policy, Management and Evaluation, have used this data tool to estimate, for the first time, the impact of hospital harm on Ontario’s health system, and the striking result is a cost upwards of $1 billion and close to 408,000 additional hospital days.
Read more about the study in White Coat, Black Art.
“Experiencing harm in hospital can extend your stay, which is well-established, but what is novel about our study is that we show that its impact extends to post-discharge health services utilization and estimate the total health system impact of that harm on our resources,” said Lauren Tessier, lead author of the study and a PhD student at IHPME.
Tessier and her fellow researchers measured the occurrence of hospital harm within patient centered episodes or PCEs, a methodology that was only recently developed by IHPME associate professor Sara Guilcher, who is also a co-author on this study.
“Using the PCE methodology allowed us to capture all acute and post-acute care information including readmissions to hospital, pharmacy use, and home care,” said Tessier. “We’ve been able to determine that hospital harm extends the time that people use health system resources and therefore, the length of their PCE.”
A PCE follows a patient over time starting from the moment they are hospitalized and captures all subsequent care until an individual has returned to the community and is stabilized for 30 days without any institutional admissions. For the purpose of this study, Tessier and colleagues examined nine specific PCE types and, as per the hospital harm measure, looked at four categories of harm, including healthcare/medication-associated conditions, infections, patient accidents and procedure-associated conditions.
Of the patients included in the study, 36,004, or approximately 6%, experienced a hospital harm during their hospitalization, with the most common type of harm, over 50%, occurring in the healthcare/medication category.
“This category of harm includes medication incidents, such as an unintended reaction or an error in dosage or administration, as well as events such as delirium and pressure ulcers,” explained Tessier.
Tessier also points out that that the findings of the study need to be balanced against its limitations including whether all adverse events are preventable.
“Hospitals are complex ecosystems,” said Tessier, “these findings are not meant to point the finger at hospitals, but rather to raise awareness on the need to collaboratively work with all relevant stakeholders, including patients, clinicians and hospital administrators, to develop action plans and provide context to these numbers.”
The study is published in the Canadian Medical Association Journal.